Greater Ozarks Rural Psychologists LLC
Organization Active NPI Clinical Psychologist · Mansfield, MO
NPI 1366779100 · NPPES record last updated Dec 14, 2009
Key facts
- NPI
- 1366779100
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2005028862 (MO)
- Legal business name
- GREATER OZARKS RURAL PSYCHOLOGISTS LLC
- Practice address
- 827 W Commercial St
Mansfield, MO 65704-9520 - Phone
- (417) 924-8188
- Fax
- (417) 924-8188
- NPI assigned
- Nov 16, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Loretta S. Fuge, PSY.D.
- Title
- Psychologist
- Phone
- (417) 924-8188
Practitioners 4
-
Loretta Fuge, PSY.D.
-
Deanna M Wolf, PSYD, LP
-
Stacy Ann Bray, PSYD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100210000240 | MO | Part B Supplier - Clinic/Group Practice | 1759424997 |
Receives reassigned benefits from 3 practitioners Practice locations: Mansfield, MO |
National Provider Directory
Locations
827 W Commercial St
Mansfield, MO 65704
Phone (417) 924-8188
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 2005028862 | MO | Yes |
Addresses
Primary practice location
827 W Commercial St
Mansfield, MO 65704-9520
Mailing address
827 W Commercial St
P.O. Box 47
Mansfield, MO 65704-9520
Phone (417) 924-8188
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316196215 | Other | MO | NPI |
Other providers in Mansfield, MO
- Kenneth H Dugan
- Everhome Hospice LLC
- Kaylee Felker
- Loretta Fuge
- Christina Giovino
- Cari Joy Hansen
- Daniel Harkey
- Max E Harkey
- Joy in the Journey Birth Doula LLC
- Lester E Cox Medical Centers
All providers in Mansfield, MO · Clinical Psychologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.