Active NPI
Michelle L Whitlock, PSY.D.
- Clinical Psychologist
- Fort Leonard Wood, MO
National Provider Identifier
1669605929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 001213
- Practice address
- 4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098 - Phone
- (573) 596-1507
- NPI assigned
- Sep 2, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 001213 | IA | Primary |
Addresses
Primary practice location
4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098
Mailing address
4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001213 | IA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456444800000",
"number": "1669605929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4430 MISSOURI AVE",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654739098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4430 MISSOURI AVE",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654739098",
"telephone_number": "573-596-1507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITLOCK",
"first_name": "MICHELLE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-02",
"last_updated": "2016-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "001213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Leonard Wood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.