NPIMap

Organization Active NPI

Brian D. Petrovich, PSYD, LPC, LLC

Doing business as Center for Psychological Health and Well-being

  • Clinical Psychologist
  • Aurora, MO
National Provider Identifier
1750553533
Registry record updated Oct 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
BRIAN D. PETROVICH, PSYD, LPC, LLC
Doing business as
Center for Psychological Health and Well-being
Practice address
308 W Church St
Aurora, MO 65605-1518
Phone
(417) 678-5532
Fax
(417) 678-6242
NPI assigned
Apr 1, 2008
Last updated
Oct 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2009

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

Authorized official

Name
Dr. Brian D Petrovich, PSYD
Title
Member
Phone
(417) 678-5532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

308 W Church St
Aurora, MO 65605-1518

Mailing address

308 W Church St
Aurora, MO 65605-1518
Phone (417) 678-5532

Other names 1

  • Center for Psychological Health and Well-being Doing business as

National Provider Directory

National Provider Directory

Locations

308 W Church St
Aurora, MO 65605
Phone (417) 678-5532

Practitioners & affiliated clinicians

Practitioners 6

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": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256515200000",
    "number": "1750553533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 W CHURCH ST",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656051518",
            "telephone_number": "417-678-5532",
            "fax_number": "417-678-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 W CHURCH ST",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656051518",
            "telephone_number": "417-678-5532",
            "fax_number": "417-678-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN D. PETROVICH, PSYD, LPC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2009-10-26",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "417-678-5532",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Psychological Health and Well-being",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; 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.