| Cultivate Psychological Services Llc | |
|
1439 S Rogers Ave Springfield MO 65804-1129 | |
| (417) 619-9818 | |
| Not Available |
| Full Name | Cultivate Psychological Services Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1439 S Rogers Ave, Springfield, Missouri |
| Authorized Official Name and Position | Shelly Jean Farnan (LICENSED PSYCHOLOGIST/OWNER/MEMBER) |
| Authorized Official Contact | 4176199818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cultivate Psychological Services Llc 331 E Water St Suite 107 Springfield MO 65806-1141 Ph: (417) 619-4466 | Cultivate Psychological Services Llc 1439 S Rogers Ave Springfield MO 65804-1129 Ph: (417) 619-9818 |
| NPI Number | 1396004990 |
|---|---|
| Provider Enumeration Date | 05/16/2012 |
| Last Update Date | 05/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396004990 | NPI | - | NPPES |
| 1962737734 | Medicaid | MO | |
| MA1019011 | Other | MEDICARE I.D. NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2009030819 (Missouri) | Primary |
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