Organization
PSYCH ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIEL A CLINE PHD (OWNER)
(417) 414-0333
Entity
Organization
Contact information
Practice address
1358 E KINGSLEY ST STE E, SPRINGFIELD, MO 65804
(417) 414-0333
(417) 268-9114
Mailing address
1358 E KINGSLEY ST STE E, SPRINGFIELD, MO 65804-7245
(417) 414-0333
(417) 268-9114
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
2010006114
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558555045
—
MO
Enumeration date
10/16/2017
Last updated
01/04/2022
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