| College Skyline Center Llc | |
|
1230 N Duquesne Rd Joplin MO 64801-1509 | |
| (417) 782-1443 | |
| (417) 782-3240 |
| Full Name | College Skyline Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1230 N Duquesne Rd, Joplin, Missouri |
| Authorized Official Name and Position | Tracy Eddington (ADMINISTRATION) |
| Authorized Official Contact | 4177821443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| College Skyline Center Llc 1230 N Duquesne Rd Joplin MO 64801-1509 Ph: (417) 782-1443 | College Skyline Center Llc 1230 N Duquesne Rd Joplin MO 64801-1509 Ph: (417) 782-1443 |
| NPI Number | 1598764110 |
|---|---|
| Provider Enumeration Date | 07/15/2005 |
| Last Update Date | 05/04/2017 |
| Medicare PECOS PAC ID | 0749383842 |
|---|---|
| Medicare Enrollment ID | O20070309000442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598764110 | NPI | - | NPPES |
| 507593408 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Charles Glenn Doyle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821073909 PECOS PAC ID: 9335107655 Enrollment ID: I20050307000245 |
| Provider Name | Angela R Gaston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225206451 PECOS PAC ID: 2062598733 Enrollment ID: I20080320000147 |
| Provider Name | Beverly Dawn Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295896405 PECOS PAC ID: 2062540503 Enrollment ID: I20100504000824 |
| Provider Name | Melinda S Burchfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013298983 PECOS PAC ID: 0345402582 Enrollment ID: I20120503000536 |
| Provider Name | Blake K Webster |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124451653 PECOS PAC ID: 5890920821 Enrollment ID: I20131030000054 |
| Provider Name | Peggy Beck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336614890 PECOS PAC ID: 7911250212 Enrollment ID: I20190329000556 |
| Provider Name | Sarah E Burch |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588386775 PECOS PAC ID: 8325410889 Enrollment ID: I20230209000428 |
| Provider Name | Lora Leigh Lombard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255099586 PECOS PAC ID: 6103289319 Enrollment ID: I20230905003174 |
| Provider Name | Judith A Kellenberger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619937414 PECOS PAC ID: 2163648387 Enrollment ID: I20231106001937 |
| Provider Name | Nicole Renee Black |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588734446 PECOS PAC ID: 7719336031 Enrollment ID: I20231214002807 |
| Provider Name | Stacia J Gilstrap |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669083796 PECOS PAC ID: 3577912518 Enrollment ID: I20231215001051 |
| Provider Name | Megan Robertson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1104299098 PECOS PAC ID: 0042669962 Enrollment ID: I20231218000741 |
| Provider Name | Shirley A. Kolkmeyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548266372 PECOS PAC ID: 3476903352 Enrollment ID: I20231219003139 |
| Provider Name | Brandi Leigh Bruner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548627136 PECOS PAC ID: 5395195192 Enrollment ID: I20231220000280 |
| Provider Name | Jerry Walker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699766089 PECOS PAC ID: 1355586629 Enrollment ID: I20231221000431 |
| Provider Name | Ellen Jane Pendley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952310278 PECOS PAC ID: 8325499197 Enrollment ID: I20240105000575 |
| Provider Name | Michael Wyczynski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669791257 PECOS PAC ID: 9931550175 Enrollment ID: I20240111003498 |
| Provider Name | Juliann A. Mcfall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386602597 PECOS PAC ID: 6901909001 Enrollment ID: I20240112001646 |
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