Healthcare Provider Details

I. General information

NPI: 1710037478
Provider Name (Legal Business Name): JIM A DELAMOTTE PSY.D., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S GLENSTONE AVE SUITE 201
SPRINGFIELD MO
65804-0313
US

IV. Provider business mailing address

1111 S GLENSTONE AVE SUITE 201
SPRINGFIELD MO
65804-0313
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-8282
  • Fax: 417-862-8805
Mailing address:
  • Phone: 417-862-8282
  • Fax: 417-862-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2000167860
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: