Provider Demographics
NPI:1003018417
Name:APPLIED PSYCHOLOGICAL CENTER, LLC
Entity Type:Organization
Organization Name:APPLIED PSYCHOLOGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN PELT
Authorized Official - Suffix:
Authorized Official - Credentials:PSY,D
Authorized Official - Phone:573-334-3329
Mailing Address - Street 1:2907 INDEPENDENCE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5044
Mailing Address - Country:US
Mailing Address - Phone:573-334-3329
Mailing Address - Fax:573-200-7006
Practice Address - Street 1:2907 INDEPENDENCE ST
Practice Address - Street 2:SUITE F
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5044
Practice Address - Country:US
Practice Address - Phone:573-334-3329
Practice Address - Fax:573-200-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506277102Medicaid
MO001976787OtherCHILD TREATMENT SERVICES
MO1821066242Medicare UPIN
MO506277102Medicaid