| Organization Name: | BOYS AND GIRLS TOWN OF MISSOURI |
| NPI Number: | 1083878839 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALFAYE JACKSON (THERAPIST) |
| Mailing Address: | 13160 County Rd 3610 St. James |
| State: | MO US |
| Postal Code: | 65559 |
| Phone Number: | 5732653251 |
| Fax Number: | |
| NPI Enumeration Date: | 07/10/2008 |
| NPI Last Update Date: | 07/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | 2008015070 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |