Bonnie D. Riley, LP, LPC
Individual provider Active NPI Psychologist · Boonville, MO
NPI 1316008014 · NPPES record last updated Jan 5, 2022
Key facts
- NPI
- 1316008014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 01427 (MO)
- Practice address
- 17244 Doyle Rd
Boonville, MO 65233-3500 - Phone
- (660) 882-2377
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000538 | MO | MD | Professional Counselor |
| 01427 | MO | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riley Equine Center, Inc. | Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities | Past |
Accepting new patients |
| Insight Dynamics LLC | Past |
Accepting new patients | |
| Walking Peace | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 000538 | MO | |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | |||
| Psychologist | 103T00000X | 01427 | MO | Yes |
Addresses
Primary practice location
17244 Doyle Rd
Boonville, MO 65233-3500
Mailing address
17244 Doyle Rd
Boonville, MO 65233-3500
Phone (660) 882-6400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6136915 | Other | MO | UNITED BEHAVIORAL HEALTH |
| 493221105 | Medicaid | MO |
Other providers in Boonville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.