Provider Demographics
NPI:1376753301
Name:BLUE SPRINGS PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:BLUE SPRINGS PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-224-6500
Mailing Address - Street 1:1924 NW COPPER OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-8300
Mailing Address - Country:US
Mailing Address - Phone:816-224-6500
Mailing Address - Fax:816-224-2777
Practice Address - Street 1:1924 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:816-224-6500
Practice Address - Fax:816-224-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00986103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1700806098OtherNPI TYPE 1
MO1700806098OtherNPI TYPE 1
MO00000744Medicare ID - Type UnspecifiedMEDICARE