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

Jacob Fantin, PLP

Individual provider Clinical Psychologist · NPI 1538883459

Jacob Fantin, PLP is a Clinical Psychologist in Monett, Missouri. Qualified in 2022, 4 years ago. Practices with Clark Community Mental Health Center, a 24-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
4
Licensed in
MO
In the registry since
2022

Practice location Address checks out

1701 N Central Ave
Monett, MO 65708-9999
Phone: (417) 476-1000
Fax: (417) 476-1082
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 2022038992 (MO)

Record details

NPI number1538883459
Entity typeIndividual (Type 1)
GenderMale
Credentials PLP
Sole proprietorNo
NPI enumeratedOctober 4, 2022
Last updated in NPPESOctober 4, 2022
Certification dateSeptember 30, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Clark Community Mental Health Center — 24 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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