417 Psych, LLC
Psychologist, Clinical in Springfield, MO. Organization (NPI-2).
NPI number1699653022
StatusActive
Last updated in NPPESAug 25, 2025
Details
- NPI
- 1699653022
- Entity type
- Organization (NPI-2)
- Legal business name
- 417 Psych, LLC
- Organization subpart
- No
- Enumeration date
- Aug 25, 2025
- Certification date
- Aug 24, 2025
- Last updated
- Aug 25, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | – | – | Yes |
Practice location
1911 S National Ave Ste 401Springfield, MO 65804-2213
Phone 417-413-1724 · Fax 417-313-0722
Mailing address
1911 S National Ave Ste 401Springfield, MO 65804-2213
Phone 417-413-1724 · Fax 417-313-0722
Authorized official
Rachael Herrington Roldan
Owner/Ceo
4174131724
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