Provider Demographics
NPI:1881781383
Name:MCGREGOR, PATRICIA L (LICENSED PSYCHOLOGIS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:MCGREGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED PSYCHOLOGIS
Mailing Address - Street 1:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2446
Mailing Address - Country:US
Mailing Address - Phone:417-621-5192
Mailing Address - Fax:417-627-9968
Practice Address - Street 1:2431 S RANGE LINE RD
Practice Address - Street 2:STE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3248
Practice Address - Country:US
Practice Address - Phone:417-621-5192
Practice Address - Fax:417-627-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01652103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496969221Medicaid