Healthcare Provider Details

I. General information

NPI: 1063422186
Provider Name (Legal Business Name): NEAL BARTON DEUTCH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 W 110TH STREET SUITE 326
OVERLAND PARK KS
66212
US

IV. Provider business mailing address

8575 W 110TH STREET SUITE 324
OVERLAND PARK KS
66210-2620
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-2727
  • Fax: 913-345-1540
Mailing address:
  • Phone: 913-345-2727
  • Fax: 913-345-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0629
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01185
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: