Provider Demographics
NPI:1083877500
Name:HOPE HOUSE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:HOPE HOUSE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIE
Authorized Official - Middle Name:SEALEY
Authorized Official - Last Name:ERVEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:417-861-9448
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:FAIR PLAY
Mailing Address - State:MO
Mailing Address - Zip Code:65649-0145
Mailing Address - Country:US
Mailing Address - Phone:417-861-9448
Mailing Address - Fax:
Practice Address - Street 1:204 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:FAIR PLAY
Practice Address - State:MO
Practice Address - Zip Code:65649-9298
Practice Address - Country:US
Practice Address - Phone:417-861-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty