Provider Demographics
NPI:1053986208
Name:MISSOURI PSYCH SERVICES LLC
Entity type:Organization
Organization Name:MISSOURI PSYCH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CONIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:330-536-3746
Mailing Address - Street 1:3593 MEDINA RD STE 181
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8182
Mailing Address - Country:US
Mailing Address - Phone:330-536-3746
Mailing Address - Fax:
Practice Address - Street 1:2733 E BATTLEFIELD ST # 612
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3981
Practice Address - Country:US
Practice Address - Phone:330-536-3746
Practice Address - Fax:330-267-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty