Organization
SUSAN SOUTHWORTH, PSY.D. LLC
Active
Organization
SUSAN SOUTHWORTH, PSY.D. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN MARIE SOUTHWORTH PSY.D. (CLINICAL PSYCHOLOGIST)
(816) 903-3800
Entity
Organization
Contact information
Practice address
302 S PLATTE CLAY WAY, SUITE 103, KEARNEY, MO 64060-8500
(816) 903-3800
(816) 903-9999
Mailing address
302 S CLAY WAY, SUITE 103, KEARNEY, MO 64060
(816) 903-3800
(816) 903-9999
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01928
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235313719
—
MO
Enumeration date
07/26/2016
Last updated
07/26/2016
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