Provider Demographics
NPI:1982875407
Name:SOUTHEAST MISSOURI BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:SOUTHEAST MISSOURI BEHAVIORAL HEALTH INC
Other - Org Name:SOUTHEAST MISSOURI COMMUNITY TREATMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
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:
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 1:5536 HWY 32
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-7357
Practice Address - Country:US
Practice Address - Phone:573-431-3341
Practice Address - Fax:573-431-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503839409Medicaid
MO503839409Medicaid