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General NPI Number Information
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NPI Number | 1083877500
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Entity Type | Organization
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Legal Business Name | HOPE HOUSE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 204 N POPLAR ST
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City | FAIR PLAY
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State | MO
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Zip | 65649-9298
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Country | US
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Telephone | 417-861-9448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | FAIR PLAY
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State | MO
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Zip | 65649-0145
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Country | US
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Telephone | 417-861-9448
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | CRISTIE SEALEY ERVEN
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Credential | PH.D.
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Telephone | 417-861-9448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2006006564
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License Number State | MO
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