Susan Southworth, Psy.D. LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

01928 Issued in MO

Legal business name

SUSAN SOUTHWORTH, PSY.D. LLC

Practice address

302 S Platte Clay Way
Suite 103
Kearney, MO 64060-8500

Phone

(816) 903-3800

Fax

(816) 903-9999

NPI assigned

Jul 26, 2016

Last updated

Jul 26, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Susan Marie Southworth, PSY.D.

Title

Clinical Psychologist

Phone

(816) 903-3800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1750834701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 S CLAY WAY",
            "address_2": "SUITE 103",
            "city": "KEARNEY",
            "state": "MO",
            "postal_code": "64060",
            "telephone_number": "816-903-3800",
            "fax_number": "816-903-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 S PLATTE CLAY WAY",
            "address_2": "SUITE 103",
            "city": "KEARNEY",
            "state": "MO",
            "postal_code": "640608500",
            "telephone_number": "816-903-3800",
            "fax_number": "816-903-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN SOUTHWORTH, PSY.D. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "SOUTHWORTH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "816-903-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "01928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235313719",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Kearney, MO
• Providers in Kearney, MO by specialty
• Clinical Psychologist in Missouri

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

Verify at the official NPI Registry.