Jackie L Dean, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2007015262 Issued in MO

Practice address

2885 W Battlefield St
Springfield, MO 65807-3952

Phone

(417) 761-5000

NPI assigned

Jun 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Burrell, Inc.

  dba Burrell Behavioral Health

  • Community/Behavioral Health Agency
  • Springfield, MO
  • NPI 1275541740
  Medicare reassignment
• Brian D. Petrovich, PSYD, LPC, LLC

  dba Center for Psychological Health and Well-being

  • Clinical Psychologist
  • Aurora, MO
  • NPI 1750553533
  NPD (past)
• Comprehensive Wellness Clinic

  • Psychiatry Physician
  • Bolivar, MO
  • NPI 1619062445

  Clinical

  NPD (past)
• Northwoods Psychiatric Services Inc

  dba Pomme de Terre Wellness Clinic

  • Psychiatry Physician
  • Bolivar, MO
  • NPI 1417902305

  Clinical

  NPD (past)

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1174728109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844715",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641844715",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 W BATTLEFIELD ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658073952",
            "telephone_number": "417-761-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAN",
        "first_name": "JACKIE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2007015262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "498802818",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler De Lap
• Joseph Milton De Vries, PLPC
• Robert Edward Deakins, MA
• William Paul Deal, PH.D.
• Dawn Dean, FNP
• Lisa Dean, LPC
• Madison Blair Dean, CAA
• Todd C. Dean, PA-C
• Heather Kristin Dearing, NP
• Hannah Deatz, MS, LPC, CSAT-A

• Clinical Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.