Healthcare Provider Details

I. General information

NPI: 1659831451
Provider Name (Legal Business Name): PHILIP A NORFOLK PHD, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NW VESPER ST
BLUE SPRINGS MO
64015-3736
US

IV. Provider business mailing address

2007 NE NEWPORT CT
BLUE SPRINGS MO
64014-1810
US

V. Phone/Fax

Practice location:
  • Phone: 816-200-0207
  • Fax: 816-326-9023
Mailing address:
  • Phone: 816-200-0207
  • Fax: 816-326-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2025030010
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31686
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: