David L. Black, PSY.D., LCSW

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

2009026793 Issued in MO

Practice address

1531 E Bradford Pkwy
Ste 210-4
Springfield, MO 65804-6566

Phone

(417) 890-4083

Fax

(417) 890-4091

NPI assigned

Jun 24, 2005

Last updated

Apr 21, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 9

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Creative Renewal & Resolutions, LLC

  dba Creative Renewal & Resolutions

  • Health Service Psychologist
  • Springfield, MO
  • NPI 1184915472
  Authorized official Same address or phone
• Advocates for a Healthy Community, Inc

  dba Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
  • NPI 1558303057
  NPD (past)

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1386640159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 E BRADFORD PKWY",
            "address_2": "STE 210-4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046566",
            "telephone_number": "417-890-4083",
            "fax_number": "417-890-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 E BRADFORD PKWY",
            "address_2": "STE 210-4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046566",
            "telephone_number": "417-890-4083",
            "fax_number": "417-890-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "DAVID",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "MO",
            "license": "2009026793",
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2001004284",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MO",
            "license": "2001004284",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494960107",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney Nicole Bixler, ATC
• Lilian Lisette Bizzocchi
• Abigail Bjerken
• Alina Christine Black, LPC
• Chelsie R Black, PSYD, LP
• Lindsey Mae Black, PNP
• Emily Nikole Blackburn
• Linda Blackburn, LPC
• Stacy L Blackington, AU.D.
• Misty Dawn Blackmon, RN

• Health Service Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Health Service Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; 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.