Provider Demographics
NPI:1215532775
Name:MISSOURI SOUTHERN STATE UNIVERSITY
Entity type:Organization
Organization Name:MISSOURI SOUTHERN STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACACIA CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:175-625-3090
Mailing Address - Street 1:3950 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1512
Mailing Address - Country:US
Mailing Address - Phone:417-625-3078
Mailing Address - Fax:
Practice Address - Street 1:3950 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1512
Practice Address - Country:US
Practice Address - Phone:417-625-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Single Specialty