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NPI Code Detail

MEDICARE: MRS. WHITNEY JEAN STILLEY PSYD, LP

MEDICARE: MRS. WHITNEY JEAN STILLEY PSYD, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2011032531MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558640615
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WHITNEY JEAN STILLEY PSYD, LP
Provider Business Mailing Address
First Line : 1300 E BRADFORD PKWY
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-4264
Country : US
Telephone Number : 417-761-5000
Fax Number : 417-761-5065
Provider Business Practice Location Address
First Line : 230 N BELCREST AVE STE A
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65802-6287
Country : US
Telephone Number : 417-413-4676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2011
Last Update Date : 08/23/2022

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