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General NPI Number Information
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NPI Number | 1376753301
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Entity Type | Organization
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Legal Business Name | BLUE SPRINGS PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 1924 NW COPPER OAKS CIR
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City | BLUE SPRINGS
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State | MO
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Zip | 64015-8300
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Country | US
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Telephone | 816-224-6500
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Fax | 816-224-2777
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Provider Business Mailing Address
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Address Line | 1924 NW COPPER OAKS CIR
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City | BLUE SPRINGS
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State | MO
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Zip | 64015-8300
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Country | US
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Telephone | 816-224-6500
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Fax | 816-224-2777
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY LEO MILLER
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Credential | PHD
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Telephone | 816-224-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00986
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License Number State | MO
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