Healthcare Provider Details

I. General information

NPI: 1790919165
Provider Name (Legal Business Name): FAMILY PSYCHOLOGY OF SPRINGFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 S WAVERLY AVE
SPRINGFIELD MO
65804-2414
US

IV. Provider business mailing address

2053 S WAVERLY AVE SUITE D
SPRINGFIELD MO
65804-2414
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-8262
  • Fax: 417-886-8109
Mailing address:
  • Phone: 417-886-8262
  • Fax: 417-886-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPYRO495
License Number StateMO

VIII. Authorized Official

Name: DR. DEBORAH L COX
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D., ABPP
Phone: 417-886-8262