Organization Name: | HOPE HOUSE PSYCHOLOGICAL SERVICES, LLC |
NPI Number: | 1083877500 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRISTIE SEALEY ERVEN (LICENSED PSYCHOLOGIST) |
Mailing Address: | 204 N Poplar St Fair Play |
State: | MO US |
Postal Code: | 656499298 |
Phone Number: | 4178619448 |
Fax Number: | |
NPI Enumeration Date: | 07/03/2008 |
NPI Last Update Date: | 07/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2006006564 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |