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1901 E Bennett St Ste H Springfield MO 65804-1434 | |
| (417) 414-9641 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1901 E Bennett St Ste H, Springfield, Missouri |
| Authorized Official Name and Position | Amy Muntz Fisch (OWNER) |
| Authorized Official Contact | 4174149641 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4807 E Eastmoor St Springfield MO 65809-3149 Ph: (417) 414-9641 | 1901 E Bennett St Ste H Springfield MO 65804-1434 Ph: (417) 414-9641 |
| NPI Number | 1689126120 |
|---|---|
| Provider Enumeration Date | 11/01/2016 |
| Last Update Date | 07/24/2024 |
| Certification Date | 07/24/2024 |
| Medicare PECOS PAC ID | 6406136860 |
|---|---|
| Medicare Enrollment ID | O20161201001227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689126120 | NPI | - | NPPES |
| 1194879593 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2010019908 (Missouri) | Primary |
| Provider Name | Amy M Fisch |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194879593 PECOS PAC ID: 8426172941 Enrollment ID: I20100903000638 |
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