Provider Demographics
NPI:1346565603
Name:PSYCHOLOGY 101, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGY 101, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:660-647-2800
Mailing Address - Street 1:613 S TEBO ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1737
Mailing Address - Country:US
Mailing Address - Phone:660-647-2800
Mailing Address - Fax:660-647-5300
Practice Address - Street 1:613 S TEBO ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1737
Practice Address - Country:US
Practice Address - Phone:660-647-2800
Practice Address - Fax:660-647-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200815723251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health