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Behavioral Health & Social Service Providers Psychologist Adult Development & Aging

Provider NPI: 1992747315

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
19401 E 40 HWY STE 130  INDEPENDENCE, MO 64055-5400 US
Tel: 816-373-6761  Fax: 816-373-6591

Business Mailing Address:
19401 E 40 HWY STE 130  INDEPENDENCE, MO 64055-5400 US
Tel: 816-373-6761  Fax: 816-373-6591

NPI Information:
NPI: 1992747315
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N103TA0700XBehavioral Health & Social Service Providers
Adult Development & Aging
MOMO 01769
N103TB0200XBehavioral Health & Social Service Providers
MOMO 01769
N103TC0700XBehavioral Health & Social Service Providers
MOMO 01769
N103TC1900XBehavioral Health & Social Service Providers
MOMO 01769
N103TC2200XBehavioral Health & Social Service Providers
MOMO 01769
N103TF0000XBehavioral Health & Social Service Providers
MOMO 01769
N103TM1800XBehavioral Health & Social Service Providers
MOMO 01769
N103TP2701XBehavioral Health & Social Service Providers
MOMO 01769
Y103T00000XBehavioral Health & Social Service Providers
MOMO 01769

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103T00000X





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