Healthcare Provider Details

I. General information

NPI: 1023178563
Provider Name (Legal Business Name): VONETTA MCCLUNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N MUR LEN RD STE 111
OLATHE KS
66062-1794
US

IV. Provider business mailing address

1211 MCGEE ST ROOM 905-C
KANSAS CITY MO
64106-2416
US

V. Phone/Fax

Practice location:
  • Phone: 913-393-4283
  • Fax: 913-393-4969
Mailing address:
  • Phone: 816-418-7840
  • Fax: 816-418-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2776
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number004755
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: