Psycare of Callaway County, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2003018483 Issued in MO

Legal business name

PSYCARE OF CALLAWAY COUNTY, LLC

Practice address

601 W Nifong, BLDG. 5a
Columbia, MO 65203

Phone

(573) 220-2366

NPI assigned

Apr 24, 2007

Organization subpart

No

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

Authorized official

Name

Mary Beth Debrodie, LCSW

Title

Ceo

Phone

(573) 220-8366

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Psycare Doing business as

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1801015342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 605",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652510605",
            "telephone_number": "573-642-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W NIFONG, BLDG. 5A",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65203",
            "telephone_number": "573-220-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCARE OF CALLAWAY COUNTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "DEBRODIE",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-220-8366",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2003018483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "498394212",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psycare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Psycare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Columbia, MO
• Providers in Columbia, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.