Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

State of Missouri

Organization Clinical Psychologist · NPI 1386691657

State of Missouri is a Clinical Psychologist in Saint Joseph, Missouri. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
3
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Practice location Address checks out

3505 Frederick Ave
Saint Joseph, MO 64506-2914
Phone: (816) 387-2300
Fax: (816) 387-2329
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X
Clinical Psychologist Taxonomy 103TC0700X
Family Medicine Physician Taxonomy 207Q00000X

Record details

NPI number1386691657
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationState of Missouri
Authorized official Molly Boeckmann — Director Of Administrative Services · (573) 751-4055
Other names Northwest Mo Psychiatric Rehabilitation Center; Northwest Mo Psychiatric Rehabilitation Center
NPI enumeratedMay 30, 2006
Last updated in NPPESSeptember 3, 2020
Certification dateSeptember 3, 2020
Mailing address1706 E Elm St, Jefferson City, MO 65101-4130

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