Chelsie R Black, PSYD, LP
Individual provider Active NPI Clinical Psychologist · Springfield, MO
NPI 1447700802 · NPPES record last updated Jul 17, 2026
Key facts
- NPI
- 1447700802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2016035949 (MO)
- Practice address
- 1300 E Bradford Pkwy BLDG B
Springfield, MO 65804-4264 - Phone
- (471) 761-5000
- Fax
- (417) 761-5011
- NPI assigned
- Oct 10, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180607002354 | MO | Practitioner - Clinical Psychologist | 9032474309 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016035949 | MO | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burrell, Inc. | Current |
Accepting new patients | |
| Burrell, Inc. | Current |
Accepting new patients |
Locations
1300 E Bradford Pkwy
Springfield, MO 65804
Phone (417) 269-5400
1300 E Bradford Pkwy
#H
Springfield, MO 65804
2885 W Battlefield St
Springfield, MO 65807
Phone (417) 761-5214
1300 E Bradford Pkwy
Bldg B
Springfield, MO 65804
Phone (417) 269-5400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2016035949 | MO | Yes |
Addresses
Primary practice location
1300 E Bradford Pkwy BLDG B
Springfield, MO 65804-4264
Mailing address
2885 W Battlefield St
Springfield, MO 65807-3952
Phone (471) 761-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490036997 | Medicaid | MO |
Other names
- Chelsie Haines
Other providers in Springfield, MO
- Lyssa Bivens
- Whitney Nicole Bixler
- Lilian Lisette Bizzocchi
- Abigail Bjerken
- Alina Christine Black
- David L. Black
- Lindsey Mae Black
- Emily Nikole Blackburn
- Linda Blackburn
- Stacy L Blackington
All providers in Springfield, 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 Jul 17, 2026. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.