NPIMap

Organization Active NPI

Psych Associates LLC

  • Health Service Psychologist
  • Springfield, MO
National Provider Identifier
1316458441
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service PsychologistTaxonomy code 103TH0100X
License
2010006114 Issued in MO
Legal business name
PSYCH ASSOCIATES LLC
Practice address
1358 E Kingsley St Ste E
Springfield, MO 65804
Phone
(417) 414-0333
Fax
(417) 268-9114
NPI assigned
Oct 16, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Gabriel A Cline, PHD
Title
Owner
Phone
(417) 414-0333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TH0100X 2010006114 MO Primary

Addresses

Primary practice location

1358 E Kingsley St Ste E
Springfield, MO 65804

Mailing address

1358 E Kingsley St Ste E
Springfield, MO 65804-7245
Phone (417) 414-0333

Other identifiers 1

IdentifierTypeStateIssuer
1558555045MedicaidMO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1316458441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1358 E KINGSLEY ST STE E",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047245",
            "telephone_number": "417-414-0333",
            "fax_number": "417-268-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1358 E KINGSLEY ST STE E",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65804",
            "telephone_number": "417-414-0333",
            "fax_number": "417-268-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCH ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-16",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "CLINE",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-414-0333",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Health Service",
            "state": "MO",
            "license": "2010006114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558555045",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.