MEDICARE: MR. TERRY WAYNE KERNES LPC

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	101YM0800X	Mental Health Counselor	119	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001027	OTHER	MO	LICENSE NUMBER

General Provider Information

NPI Number	:	1366556177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY WAYNE KERNES LPC

Provider Business Mailing Address
First Line	:	2105 SW SMITH ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3505
Country	:	US
Telephone Number	:	816-229-3009
Fax Number	:	816-229-3009

Provider Business Practice Location Address
First Line	:	520 GARFIELD AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-1514
Country	:	US
Telephone Number	:	816-404-6352
Fax Number	:	816-404-6347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/06/2023

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