| NPI | 1962701755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY D DODGE Owner 913-232-6861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2002011102) |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2012-09-05 |