Provider Demographics
NPI:1346331642
Name:MORRISSEY, ROBERT D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:MORRISSEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARK PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672
Mailing Address - Country:US
Mailing Address - Phone:417-300-3532
Mailing Address - Fax:
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:SUITE B-116
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-881-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-25103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497339101Medicare ID - Type Unspecified