Healthcare Provider Details

I. General information

NPI: 1205612843
Provider Name (Legal Business Name): MADELINE TRAHAN LARROW PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE BLAIR TRAHAN PSYD

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 HITT ST
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-7570
  • Fax: 573-884-4899
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number202301
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2024036724
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: