Healthcare Provider Details

I. General information

NPI: 1891976254
Provider Name (Legal Business Name): JARED PHILIP PINGLETON PSY,D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 STATE HIGHWAY 248
BRANSON MO
65616-9240
US

IV. Provider business mailing address

2527 STATE HIGHWAY 248
BRANSON MO
65616-9240
US

V. Phone/Fax

Practice location:
  • Phone: 417-339-4041
  • Fax: 417-336-0909
Mailing address:
  • Phone: 417-339-4041
  • Fax: 417-336-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01240
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: