NORTHEAST FAMILY HEALTH ANNEX
NPI 1336679836
Psychologist in Kirksville, MO

Active since June 16, 2017CLIA 26D0953184 · Waiver
1410 CROWN DR, KIRKSVILLE, MO 63501(660) 627-4493 Get Directions Write a Review

NPPES record last updated: July 10, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 10, 2017, Jun 16, 2017 (2 updates tracked since 2017).

About Northeast Family Health Annex NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHEAST FAMILY HEALTH ANNEX (NPI 1336679836) is a healthcare organization registered as a psychologist in Kirksville, Missouri and active in the NPI registry since June 2017. The organization holds a CLIA Waiver certificate valid through May 8, 2028 and lists Andrew Grimm, Ceo, as its authorized official.

NPPES Registry Identity

NPI1336679836
Entity TypeOrganization
Primary Taxonomy103T00000X
Legal Business NameNORTHEAST MISSOURI HEALTH COUNCIL INC
Location Address1410 CROWN DRKirksville, MO 63501-2548
Mailing Address1416 Crown DrKirksville, MO 63501-2548 · (660) 627-5757
Organization SubpartNo
Authorized OfficialAndrew GrimmCeo · (660) 627-5757
Enumeration DateJune 16, 2017
Last NPPES UpdateJuly 10, 20172 updates tracked since enumeration
NPI 1336679836 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedFamily MedicineTaxonomy 207Q00000X
1410 CROWN DR, Kirksville, MO 63501

Other Names 1

Doing Business AsNortheast Family Health Annex

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D0953184

Northeast Missouri Family Health · Kirksville, MO
Active · expires May 8, 2028
CLIA Number26D0953184
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateMay 9, 2026
Certificate Expiration DateMay 8, 2028
Laboratory DirectorHeather Martin
Laboratory Phone(660) 627-4493
Laboratory LocationNortheast Missouri Family Health1506 Crown Drive, Kirksville, MO 63501
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
1410 CROWN DR
KIRKSVILLE, MO 63501
Social Worker (Clinical)
1410 CROWN DR
KIRKSVILLE, MO 63501

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northeast Missouri Health Council Inc's NPI number?

The NPI number for Northeast Missouri Health Council Inc is 1336679836. It was assigned to this organization in the NPPES registry on June 16, 2017. The provider is doing business as Northeast Family Health Annex.

Where is Northeast Missouri Health Council Inc located?

Northeast Missouri Health Council Inc is located at 1410 Crown Dr, Kirksville, MO 63501. The listed phone number is (660) 627-4493.

What is Northeast Missouri Health Council Inc's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Does Northeast Missouri Health Council Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0953184) is associated with this NPI, valid through May 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Northeast Missouri Health Council Inc accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health and Ambetter from Sunflower Health Plan and 2 other insurers list Northeast Missouri Health Council Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northeast Missouri Health Council Inc was last updated on July 10, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.