Healthcare Provider Details

I. General information

NPI: 1588568943
Provider Name (Legal Business Name): MARCUS RELPHORDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 SHAWNEE MISSION PKWY STE 301
OVERLAND PARK KS
66202-4002
US

IV. Provider business mailing address

18256 EARNSHAW ST
OVERLAND PARK KS
66013-4529
US

V. Phone/Fax

Practice location:
  • Phone: 816-455-9433
  • Fax:
Mailing address:
  • Phone: 816-455-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05573
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: