Psylin, Inc.

Key facts

NPI

1265735294

Entity type

Organization (NPI type 2)

Primary specialty

Clinical Psychologist 103TC0700X

License

2001014377 (MO)

Legal business name

PSYLIN, INC.

Practice address

22901 S Ridgeview Dr
Peculiar, MO 64078-0195

Phone

(417) 321-4881

Fax

(866) 223-4072

NPI assigned

Dec 14, 2010

Organization subpart

No

Authorized official

Name

Dr. Christopher Carlin, PSY.D. NPI 1740264241

Title

President

Phone

(417) 321-4881

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher J Carlin, PSY.D. Clinical Psychologist · Peculiar, MO · NPI 1740264241
  Medicare reassignment NPD Authorized official CLINICAL · MO
• Christina A McDowell, LSCSW Clinical Social Worker · Kansas City, MO · NPI 1265401863
  NPD (past)
• Bradford Lewis Shull, D.C. Chiropractor · Nevada, MO · NPI 1457357840
  NPD (past)
• Jacinda Rea, LCSW Clinical Social Worker · Miami, OK · NPI 1730457300
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MO

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 31, 2024.

{
    "created_epoch": "1292284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1265735294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22901 S RIDGEVIEW DR",
            "city": "PECULIAR",
            "state": "MO",
            "postal_code": "640780195",
            "telephone_number": "417-321-4881",
            "fax_number": "866-223-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22901 S RIDGEVIEW DR",
            "city": "PECULIAR",
            "state": "MO",
            "postal_code": "640780195",
            "telephone_number": "417-321-4881",
            "fax_number": "866-223-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYLIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-14",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "CARLIN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-321-4881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2001014377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH #",
            "identifier": "11461940",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA3108",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265735294",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peculiar, MO

• Peculiar Medical Clinic
• Peculiar Pharmacy LLC
• Lucinda Pennington, MS, MA
• Sheryl Lynn Phillips, RPH
• Stacie Leah Pruett, FNP
• Raymore-Peculiar Reorganized School
• Emma Jane Rewerts
• Rummerfield Chiropractic LLC
• Kenneth W Rummerfield, D.C.
• Laveeda C Simmons, MSW

All providers in Peculiar, MO · Clinical Psychologist in Missouri