Provider Demographics
NPI:1306999511
Name:BOYS AND GIRLS TOWN OF MISSOURI
Entity type:Organization
Organization Name:BOYS AND GIRLS TOWN OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BELL COTTAGE CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CRC, LPC
Authorized Official - Phone:573-265-3251
Mailing Address - Street 1:17051 HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-8222
Mailing Address - Country:US
Mailing Address - Phone:573-265-1959
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY ROAD 3610
Practice Address - Street 2:BOYS & GIRLS TOWN OF MISSOURI
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO322D00000X322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children