Provider Demographics
NPI:1265735294
Name:PSYLIN, INC.
Entity type:Organization
Organization Name:PSYLIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-321-4881
Mailing Address - Street 1:22901 S RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-0195
Mailing Address - Country:US
Mailing Address - Phone:417-321-4881
Mailing Address - Fax:866-223-4072
Practice Address - Street 1:22901 S RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-0195
Practice Address - Country:US
Practice Address - Phone:417-321-4881
Practice Address - Fax:866-223-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11461940OtherCAQH #
MOMA3108OtherMEDICARE PTAN
MO1265735294Medicaid
MOMA3108OtherMEDICARE PTAN