Provider Demographics
NPI:1275083495
Name:JEFFRIES, CODY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 E DADE 68
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65635-8112
Mailing Address - Country:US
Mailing Address - Phone:417-637-1476
Mailing Address - Fax:866-520-5586
Practice Address - Street 1:406 COLLEGE ST
Practice Address - Street 2:#2
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-1346
Practice Address - Country:US
Practice Address - Phone:417-637-1476
Practice Address - Fax:866-520-5586
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical