Diana M Bastien, LP
Individual provider Active NPI Clinical Psychologist · Springfield, MO
NPI 1942789201 · NPPES record last updated Oct 4, 2021
Key facts
- NPI
- 1942789201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2018030620 (MO)
- Practice address
- 1300 E Bradford Pkwy
Springfield, MO 65804-4294 - Phone
- (417) 761-5000
- Fax
- (417) 761-5065
- NPI assigned
- Aug 8, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective Dec 1, 2023 through Dec 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Interoperability endpoints
- dbastien361077@direct.seattlechildrens.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2018030620 | MO | Yes |
Addresses
Primary practice location
1300 E Bradford Pkwy
Springfield, MO 65804-4294
Mailing address
1300 E Bradford Pkwy
Springfield, MO 65804-4294
Phone (417) 761-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490058980 | Medicaid | MO |
Other providers in Springfield, MO
- Aamir Bashir
- Natasha M Bass
- Randy Joe Bass
- Cole Timothy Bassett
- Krista Nicole Bassett
- Taylor Baswell
- Guy Phillip Bates Jr.
- Inna L. Bates
- Samantha C Bathon
- Alicia Batten
All providers in Springfield, MO · Clinical Psychologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.