| NPI | 1043421480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA S. DAVENPORT Owner 816-225-0562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: MO 2007015259) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO LPC-2004033828) |
| 103T00000X Psychologist (Licence: KS LP-1639) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2009-01-04 |