| Center Of Change | |
|
1615a S Ingram Mill Rd Springfield MO 65804-2261 | |
| (417) 888-0886 | |
| (417) 888-0846 |
| Full Name | Center Of Change |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1615a S Ingram Mill Rd, Springfield, Missouri |
| Authorized Official Name and Position | Suzanne Mckenna (CO-OWNER) |
| Authorized Official Contact | 4178880886 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Of Change 1615a S Ingram Mill Rd Springfield MO 65804-2261 Ph: (417) 888-0886 | Center Of Change 1615a S Ingram Mill Rd Springfield MO 65804-2261 Ph: (417) 888-0886 |
| NPI Number | 1679741144 |
|---|---|
| Provider Enumeration Date | 02/18/2008 |
| Last Update Date | 05/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679741144 | NPI | - | NPPES |
| 508440609 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY01825 (Missouri) | Primary |
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