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DR. DAVID L. BLACK PSY.D., LCSW

Behavioral Health & Social Service Providers Marriage & Family Therapist

Provider NPI: 1386640159

Provider Information:
DR. DAVID L. BLACK PSY.D., LCSW
Gender: M
Not Sole Proprietor

Practice Location:
1531 E BRADFORD PKWY STE 210-4 SPRINGFIELD, MO 65804-6566 US
Tel: 417-890-4083  Fax: 417-890-4091

Business Mailing Address:
1531 E BRADFORD PKWY STE 210-4 SPRINGFIELD, MO 65804-6566 US
Tel: 417-890-4083  Fax: 417-890-4091

NPI Information:
NPI: 1386640159
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist
MO2001004284
N103TA0400XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
N103TP2701XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
N103TC1900XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
N103TC2200XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
Y103TH0100XBehavioral Health & Social Service Providers
Psychologist
MO2009026793
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
MO2001004284

Other Provider Identifiers:

IssuerNumberStateType
494960107MO05



American Medical Association 2012 taxonomy code information

Code: 103TH0100X

Type:

Classification:



Definition:



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