Provider Demographics
NPI:1770810269
Name:RURAL MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:RURAL MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-343-3579
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-0677
Mailing Address - Country:US
Mailing Address - Phone:417-924-2059
Mailing Address - Fax:417-924-2069
Practice Address - Street 1:812 N HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704-7301
Practice Address - Country:US
Practice Address - Phone:417-924-2059
Practice Address - Fax:417-924-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499037620Medicaid
MO000022130Medicare UPIN