MEDICARE: FAMILY FIRST CENTER FOR AUTISM AND CHILD DEVELOPMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1154626893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST CENTER FOR AUTISM AND CHILD DEVELOPMENT, INC.

Provider Business Mailing Address
First Line	:	5863 NW 72ND ST
Second Line	:	SUITE 180
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-1483
Country	:	US
Telephone Number	:	816-984-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5863 NW 72ND ST
Second Line	:	SUITE 180
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-1483
Country	:	US
Telephone Number	:	816-984-8282
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR
Name	:	DR. FARRELL WEIERS
Credential	:	PHD
Telephone Number	:	816-876-9352

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	04/07/2017

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