MEDICARE: CASSANDRA BABALOLA S-LMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1477230688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA BABALOLA S-LMFT

Provider Business Mailing Address
First Line	:	2208 W 123RD TER
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209-1315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4116 BALTIMORE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2303
Country	:	US
Telephone Number	:	816-405-8118
Fax Number	:

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

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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