Provider Demographics
NPI:1497950521
Name:MCGREEVY, MICHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCGREEVY
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 1:2117 S STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2548
Mailing Address - Country:US
Mailing Address - Phone:417-885-0027
Mailing Address - Fax:
Practice Address - Street 1:2117 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2548
Practice Address - Country:US
Practice Address - Phone:417-885-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY-01732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist