Active NPI
Mary Eleanor Givens, PHD
- Clinical Psychologist
- Rolla, MO
National Provider Identifier
1871019711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2017024119
- Practice address
- 1450 E 10TH St
Rolla, MO 65401-3648 - Phone
- (573) 364-7551
- NPI assigned
- Aug 22, 2017
- 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 | 2017024119 | MO | Primary |
Addresses
Primary practice location
1450 E 10TH St
Rolla, MO 65401-3648
Mailing address
650B Salem Ave
Rolla, MO 65401-3409
Phone (785) 550-3715
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017024119 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511827200000",
"number": "1871019711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650B SALEM AVE",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013409",
"telephone_number": "785-550-3715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 E 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013648",
"telephone_number": "573-364-7551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIVENS",
"first_name": "MARY",
"middle_name": "ELEANOR",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-22",
"last_updated": "2017-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2017024119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.