Provider Demographics
NPI:1891213096
Name:SIX, MOLLY KAY (PHD, LP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KAY
Last Name:SIX
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:K
Other - Last Name:BEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:230 N BELCREST AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6287
Practice Address - Country:US
Practice Address - Phone:417-413-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MO2018007648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490046467Medicaid