Provider Demographics
NPI:1194024638
Name:ALBANY BEHAVIORAL HEALTH SERVICES L.L.C
Entity type:Organization
Organization Name:ALBANY BEHAVIORAL HEALTH SERVICES L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:660-853-1322
Mailing Address - Street 1:113 N SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-1250
Mailing Address - Country:US
Mailing Address - Phone:660-853-1322
Mailing Address - Fax:
Practice Address - Street 1:113 N SMITH ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-1250
Practice Address - Country:US
Practice Address - Phone:660-853-1322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033597101YP2500X
MO20030290381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588973929OtherNPI MARY-JENNIFER QUINLEY
MO1710910955OtherNPI FOR JANE M. WILMES