Provider Demographics
NPI:1154144020
Name:PROACTIVE BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:PROACTIVE BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-242-7718
Mailing Address - Street 1:6389 HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-2044
Mailing Address - Country:US
Mailing Address - Phone:217-242-7718
Mailing Address - Fax:816-631-0171
Practice Address - Street 1:1654 BRYAN RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4897
Practice Address - Country:US
Practice Address - Phone:636-344-0433
Practice Address - Fax:816-631-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty