| Serenity Psychological Services, Llc | |
|
636 W Republic Rd Ste C104 Springfield MO 65807-5806 | |
| (417) 507-2407 | |
| (417) 413-2763 |
| Full Name | Serenity Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 636 W Republic Rd Ste C104, Springfield, Missouri |
| Authorized Official Name and Position | Samantha Dugan (OWNER/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4174144419 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity Psychological Services, Llc 2131 W Republic Rd # 179 Springfield MO 65807-5705 Ph: (417) 414-4419 | Serenity Psychological Services, Llc 636 W Republic Rd Ste C104 Springfield MO 65807-5806 Ph: (417) 507-2407 |
| NPI Number | 1154995090 |
|---|---|
| Provider Enumeration Date | 05/15/2021 |
| Last Update Date | 05/15/2021 |
| Certification Date | 05/15/2021 |
| Medicare PECOS PAC ID | 8325434970 |
|---|---|
| Medicare Enrollment ID | O20220406002995 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154995090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rosemary Rubenstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689645509 PECOS PAC ID: 4183617400 Enrollment ID: I20040405000351 |
| Provider Name | Sherrie K Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528491529 PECOS PAC ID: 9234411430 Enrollment ID: I20171109000636 |
| Provider Name | Samantha R Dugan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467824763 PECOS PAC ID: 1759703127 Enrollment ID: I20200612002150 |
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