Provider Demographics
NPI:1932504305
Name:A & M RECOVERY
Entity Type:Organization
Organization Name:A & M RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CRADC
Authorized Official - Phone:417-823-3808
Mailing Address - Street 1:3322 S CAMPBELL AVE
Mailing Address - Street 2:SUITE P
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4980
Mailing Address - Country:US
Mailing Address - Phone:417-823-3808
Mailing Address - Fax:
Practice Address - Street 1:3322 S CAMPBELL AVE
Practice Address - Street 2:SUITE P
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4980
Practice Address - Country:US
Practice Address - Phone:417-823-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBUSA200801401251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health