Psychotherapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PSYCHOTHERAPY LLC

Practice address

508 N Truman Blvd Ste F
Crystal City, MO 63019-1344

Phone

(636) 931-8784

Fax

(636) 465-0026

NPI assigned

Oct 6, 2023

Last updated

Jul 3, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana BlackwellNPI 1811088446

Title

Clinical Social Worker

Phone

(573) 315-5549

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Diana Blackwell, LCSW

  • Clinical Social Worker
  • Crystal City, MO
  • NPI 1811088446
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783036800000",
    "number": "1164203188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 N TRUMAN BLVD STE F",
            "city": "CRYSTAL CITY",
            "state": "MO",
            "postal_code": "630191344",
            "telephone_number": "636-931-8784",
            "fax_number": "636-465-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 N TRUMAN BLVD STE F",
            "city": "CRYSTAL CITY",
            "state": "MO",
            "postal_code": "630191344",
            "telephone_number": "636-931-8784",
            "fax_number": "636-465-0026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8135 Berry Rd",
            "address_purpose": "LOCATION",
            "city": "Bonne Terre",
            "state": "MO",
            "postal_code": "636284355",
            "country_code": "US",
            "telephone_number": "573-315-5549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2026-07-03",
        "certification_date": "2026-07-03",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "573-315-5549"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Phelps
• Nancy A Pippin, M.ED.
• Dustin John Politte-Bender, MT-BC
• Erin M Poniewaz, LPC
• Premiere Eye Associates, P.C. (InSight Optical)
• Lisa Ann Ramacher, PT
• Rebel Wellness, LLC (Balanced Wellness)
• Melani Saito, PLPC
• Earl Scott, MD
• Janet Sinks, RN CS FNP

• Clinical Social Worker in Crystal City, MO
• Providers in Crystal City, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.