Provider Demographics
NPI:1881731230
Name:CLARK COMMUNITY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:CLARK COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-235-6610
Mailing Address - Street 1:307 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-2316
Mailing Address - Country:US
Mailing Address - Phone:417-235-6610
Mailing Address - Fax:417-236-0058
Practice Address - Street 1:307 4TH ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2316
Practice Address - Country:US
Practice Address - Phone:417-235-6610
Practice Address - Fax:417-236-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020075481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty