STATE OF MISSOURI (NPI# 1578199238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578199238 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | CPR YOUTH |
| Practice Address |
1706 E Elm St Jefferson City MO 65101-4130 |
| Mailing Address |
Po Box 687 1706 E Elm St Jefferson City MO 65102-0687 |
| Practice Telephone | 5737513398 |
| Mailing Telephone | 5737513398 |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Telephone | 5737514055 |
| Is Organization Subpart | Y |
| Parent Organization Name | STATE OF MISSOURI |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TR0400X |
Psychologist Specialization: Rehabilitation |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| CPR Youth | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437781499 | State of Missouri | Rehabilitation Counselor | 3418 Knipp Dr, Jefferson City, MO 65109-5701 | 2020-02-07 |
| 1275073280 | State of Missouri | General Practice | 1547 W Commerce Drive, Marshall, MO 65340-3907 | 2017-02-24 |
| 1528333085 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 N Colorado St, Nevada, MO 64772-1618 | 2012-03-16 |
| 1386843621 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15555 Little Blue Rd, Kansas City, MO 64139 | 2007-07-17 |
| 1922207679 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5410 Rinker Rd, Kansas City, MO 64129-2308 | 2007-07-13 |
| 1760681415 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1501 N River Blvd, Independence, MO 64050-1760 | 2007-07-13 |
| 1164630463 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 11 Brady Cir, Overland, MO 63114-1110 | 2007-05-18 |
| 1548322605 | State of Missouri | Day Training, Developmentally Disabled Services | 1500 Vandiver Dr Ste 100, Columbia, MO 65202-3932 | 2006-12-15 |
| 1366503153 | State of Missouri | Day Training, Developmentally Disabled Services | 471 E Slater St, Marshall, MO 65340 | 2006-12-13 |
| 1427118033 | State of Missouri | Day Training, Developmentally Disabled Services | 522 Star St, Marshall, MO 65340 | 2006-12-12 |
| Street Address |
1706 E ELM ST |
| City | JEFFERSON CITY |
| State | MO |
| Zip Code | 65101-4130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659534386 | Cynthia L Hackathorn | Counselor | 1706 E Elm St, Jefferson City, MO 65102 | 2008-07-02 |
| 1316573074 | State of Missouri | Case Manager/Care Coordinator | 1706 E Elm St, Jefferson City, MO 65101-4130 | 2020-03-13 |
| 1801422621 | State of Missouri | Community/Behavioral Health | 1706 E Elm St, Jefferson City, MO 65101-4130 | 2020-03-13 |
| 1184259913 | State of Missouri | Counselor | 1706 E Elm St, Jefferson City, MO 65101-4130 | 2020-03-12 |
| 1447886288 | State of Missouri | Psychologist | 1706 E Elm St, Jefferson City, MO 65101 | 2020-03-12 |
| 1871128645 | State of Missouri | Case Manager/Care Coordinator | 1706 E Elm St, Jefferson City, MO 65101-4130 | 2020-03-11 |
| 1134577653 | Missouri Department of Mental Health | Clinic/Center | 1706 E Elm St, Jefferson City, MO 65101-4130 | 2016-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619468527 | Lhcg Cxxxxiii, LLC | Home Health | 1125 Madison St Ste C, Jefferson City, MO 65101 | 2018-05-25 |
| 1396254629 | Lauren Mellon | Speech-Language Pathologist | 6124 Falcon Lane, Jefferson City, MO 65101 | 2017-09-29 |
| 1518375708 | Daven Nanda | Pharmacist | 2101 N Schotthill Woods Dr., Jefferson City, MO 65101 | 2014-07-31 |
| 1699183228 | Mark Nitz | Pharmacist | 2101 N Schotthill Dr, Jefferson City, MO 65101 | 2014-07-28 |
| 1386923472 | Lorinda Jo Leer | Occupational Therapist | 1403 Riverside Drive, Jefferson City, MO 65101 | 2011-08-08 |
| 1124334503 | Kimberly K Baumhoer | Hearing Instrument Specialist | 315 Ellis Blvd. Suite 202, Hearing Aid Consultants, Jefferson City, MO 65101 | 2010-08-24 |
| 1780867341 | Health Enhancements, P.C. | Family Medicine | 1739 Elm Court Plaza, Suite 106, Jefferson City, MO 65101 | 2007-12-06 |
| 1336364819 | Jerome Satorre | Occupational Therapist | 505 Ellis Blvd, Apt B20, Jefferson, MO 65101 | 2007-04-17 |
| 1326263450 | Bryan M. Pope, Dds Inc. | Dentist | 200 St. Mary's Medical Plaza, Suite 101, Jefferson City, MO 65101 | 2007-04-16 |
| 1104948769 | Kenneth Mark Skouby | Social Worker | 515a East Mccarty, Jefferson City, MO 65101 | 2007-04-04 |
| Find all providers in zip 65101 | ||||
| Taxonomy Code | 103TR0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447886288 | State of Missouri | Psychologist | 1706 E Elm St, Jefferson City, MO 65101 | 2020-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013912484 | Bonnie B. Walbran | Psychologist | 859 Edlin Dr, Saint Louis, MO 63122-1615 | 2005-06-14 |
| 1568811354 | Danasty Marie Lewis | Psychologist | 3001 Warrior Lane, Poplar Bluff, MO 63901 | 2016-06-13 |
| 1104980267 | East Central Missouri Behavioral Health Services, Inc | Psychologist | 340 Kelley Pkwy, Mexico, MO 65265-3811 | 2006-12-21 |
| 1457415515 | East Central Missouri Behavioral Health Services, Inc | Psychologist | 340 Kelley Pkwy, Mexico, MO 65265 | 2006-12-21 |
| 1376607432 | East Central Missouri Behavioral Health Serives, Inc | Psychologist | 340 Kelley Pkwy, Mexico, MO 65265-3811 | 2006-12-21 |
| 1356404636 | East Central Missouri Behavioral Health Services, Inc | Psychologist | 340 Kelley Pkwy, Mexico, MO 65265 | 2006-12-18 |
| City | JEFFERSON CITY |
| Zip Code | 65101 |
Please comment or provide details below to improve the information on STATE OF MISSOURI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.