MEDICARE: CAROL SHRIVER PSYD

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
1	103TC0700X	Clinical Psychologist	R0521	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1811037237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SHRIVER PSYD

Provider Business Mailing Address
First Line	:	4319 S NATIONAL AVE STE 201
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2607
Country	:	US
Telephone Number	:	417-844-3768
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 W OAKHAVEN LN
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-1948
Country	:	US
Telephone Number	:	417-844-3768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	11/06/2023

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Directions to “ CAROL SHRIVER PSYD” Practice Location

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