Healthcare Provider Details

I. General information

NPI: 1114096385
Provider Name (Legal Business Name): PSYCHIATRIC AND COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 W 110TH ST. STE 100
OVERLAND PARK KS
66210-2307
US

IV. Provider business mailing address

25101 CHAGRIN BLVD STE 100
BEACHWOOD OH
44122-5694
US

V. Phone/Fax

Practice location:
  • Phone: 913-327-7505
  • Fax: 216-456-8128
Mailing address:
  • Phone: 253-346-0392
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN B PARDO
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 425-279-8500