Provider Demographics
NPI:1720261639
Name:SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRON
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRATTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-431-0554
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:512 E. MAIN ST.
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0506
Mailing Address - Country:US
Mailing Address - Phone:573-431-0554
Mailing Address - Fax:573-431-5205
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2634
Practice Address - Country:US
Practice Address - Phone:573-431-3341
Practice Address - Fax:573-431-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty