| Jcmg Mental Health Clinic Llc | |
|
1303 Edgewood Dr Jefferson City MO 65109-1943 | |
| (573) 634-5400 | |
| (573) 636-2639 |
| Full Name | Jcmg Mental Health Clinic Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1303 Edgewood Dr, Jefferson City, Missouri |
| Authorized Official Name and Position | Jeffrey Lee Patrick (PRESIDENT/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 5736355264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jcmg Mental Health Clinic Llc Po Box 104240 Jefferson City MO 65110-4240 Ph: () - | Jcmg Mental Health Clinic Llc 1303 Edgewood Dr Jefferson City MO 65109-1943 Ph: (573) 634-5400 |
| NPI Number | 1801951306 |
|---|---|
| Provider Enumeration Date | 12/26/2006 |
| Last Update Date | 08/30/2023 |
| Certification Date | 08/30/2023 |
| Medicare PECOS PAC ID | 7810900297 |
|---|---|
| Medicare Enrollment ID | O20070723000055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801951306 | NPI | - | NPPES |
| Provider Name | Ann M Pollock |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124109079 PECOS PAC ID: 1254345424 Enrollment ID: I20060127000043 |
| Provider Name | Jennifer Michele Patrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831182427 PECOS PAC ID: 0941495675 Enrollment ID: I20101108001166 |
| Provider Name | Elisabeth Ashley Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194436246 PECOS PAC ID: 9537539051 Enrollment ID: I20221228000165 |
| Provider Name | Olivia Riegel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952118226 PECOS PAC ID: 9638607591 Enrollment ID: I20250107000790 |
| Provider Name | Stephanie Michelle Lorance |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801121652 PECOS PAC ID: 9638607369 Enrollment ID: I20250109000701 |
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