| NPI | 1164458931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN ANDREW FIDLER Business Administrator 816-373-9240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MO 0007690) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: MO 0007690) |
| 101YP2500X Counselor Professional (Licence: MO 0007690) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MO 0007690) | |
| 103TC0700X Psychologist Clinical (Licence: MO 0007690) | |
| 103TC1900X Psychologist Counseling (Licence: MO 0007690) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MO 0007690) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 0007690) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2009-04-16 |