=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437182938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RURAL PSYCHOLOGISTS & ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 05/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 812 N HWY 5
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-924-2059
-----------------------------------------------------
Fax | 417-924-2069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 677
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65704-0677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-924-2059
-----------------------------------------------------
Fax | 417-924-2069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. JANICE L. MAY
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 417-343-3579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------