Unknown Individual – Clinical Psychologist, NPI 1114090263

Unknown Individual is a healthcare provider. based in Springfield, Missouri. specializing in Clinical Psychologist. They hold a License No. 2006036652 (MO). The NPI Number for Unknown Individual is 1114090263

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114090263
Phone
(417) 761-5000
Address
1300 E BRADFORD PKWY
Deactivation Date
16 October 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3145340200415
Graduation Year
2003 (23 years ago)
PAC ID
1850393422
Group Practice PAC ID
3173428638
Professional Enrollment ID
I20070212000004
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Burrell Behavioral Health, 1300, East Bradford Parkway, Springfield, Greene County, Missouri, 65804, United States

    SPRINGFIELD, MO 658044264

    Phone: (417) 761-5000

    Fax: (417) 761-5011

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 65804)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3173428638View full group profile
NameSpecialtyState
Nurse PractitionerMO
Clinical PsychologistMO
Clinical Social WorkerMO
Clinical PsychologistSC
P S Y C H I A T R YMO
Clinical PsychologistMO
Clinical Social WorkerMO
-MO
Clinical Social WorkerMO
P S Y C H I A T R YMO

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1114090263.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Springfield, Missouri in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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