Provider Demographics
NPI:1508015371
Name:PSYCHOLOGICAL ASSOCIATES OF SOUTHWEST MISSOURI, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF SOUTHWEST MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:417-455-5875
Mailing Address - Street 1:PO BOX 5609
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-0609
Mailing Address - Country:US
Mailing Address - Phone:417-455-5875
Mailing Address - Fax:
Practice Address - Street 1:1110 W HARMONY ST STE D
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1638
Practice Address - Country:US
Practice Address - Phone:417-455-5875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MO2002030466103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty