NPIMap

Organization Active NPI

Center of Change

  • Clinical Psychologist
  • Springfield, MO
National Provider Identifier
1679741144
Registry record updated May 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY01825 Issued in MO
Legal business name
CENTER OF CHANGE
Practice address
1615A S Ingram Mill Rd
Springfield, MO 65804-2261
Phone
(417) 888-0886
Fax
(417) 888-0846
NPI assigned
Feb 18, 2008
Last updated
May 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2008

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

Authorized official

Name
Suzanne McKenna, PHDNPI 1316943095
Title
Co-Owner
Phone
(417) 888-0886

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY01825 MO Primary

Addresses

Primary practice location

1615A S Ingram Mill Rd
Springfield, MO 65804-2261

Mailing address

1615A S Ingram Mill Rd
Springfield, MO 65804-2261
Phone (417) 888-0886

Other identifiers 1

IdentifierTypeStateIssuer
508440609MedicaidMO

National Provider Directory

National Provider Directory

Locations

1615A S Ingram Mill Rd
Springfield, MO 65804
Phone (417) 888-0886

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1679741144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615A S INGRAM MILL RD",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042261",
            "telephone_number": "417-888-0886",
            "fax_number": "417-888-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615A S INGRAM MILL RD",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042261",
            "telephone_number": "417-888-0886",
            "fax_number": "417-888-0846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER OF CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-18",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "417-888-0886",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "PY01825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508440609",
            "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 May 1, 2008; 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.