Healthcare Provider Details

I. General information

NPI: 1265735294
Provider Name (Legal Business Name): PSYLIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22901 S RIDGEVIEW DR
PECULIAR MO
64078-0195
US

IV. Provider business mailing address

22901 S RIDGEVIEW DR
PECULIAR MO
64078-0195
US

V. Phone/Fax

Practice location:
  • Phone: 417-321-4881
  • Fax: 866-223-4072
Mailing address:
  • Phone: 417-321-4881
  • Fax: 866-223-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2001014377
License Number StateMO

VIII. Authorized Official

Name: DR. CHRISTOPHER CARLIN
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 417-321-4881