Healthcare Provider Details

I. General information

NPI: 1821313081
Provider Name (Legal Business Name): EXPRESS PSYCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 E 32ND ST SUITE 9
JOPLIN MO
64804-3156
US

IV. Provider business mailing address

2727 E 32ND ST SUITE 9
JOPLIN MO
64804-3156
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-7200
  • Fax: 417-781-7202
Mailing address:
  • Phone: 417-781-7200
  • Fax: 417-781-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA LYNN FAILLE
Title or Position: ADULT PSYCHIATRIC CLINICAL NURSE SP
Credential: RN, AP/MHCNSBC
Phone: 417-781-7200