Active NPI
Micah Osborne Mazurek, PH.D.
- Clinical Psychologist
- Columbia, MO
National Provider Identifier
1164575965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2006016143
- Practice address
- 205 Portland St
Columbia, MO 65201-6521 - Phone
- (573) 884-8502
- Fax
- (573) 884-6421
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2006016143 | MO | Primary |
Addresses
Primary practice location
205 Portland St
Columbia, MO 65201-6521
Mailing address
PO Box 7687
Columbia, MO 65205-7687
Phone (573) 882-2259
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11616561 | Other | MO | CAQH PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006016143 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288224000000",
"number": "1164575965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7687",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652057687",
"telephone_number": "573-882-2259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 PORTLAND ST",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016521",
"telephone_number": "573-884-8502",
"fax_number": "573-884-6421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZUREK",
"first_name": "MICAH",
"middle_name": "OSBORNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2010-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2006016143",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11616561",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.