Healthcare Provider Details

I. General information

NPI: 1366423337
Provider Name (Legal Business Name): LENNIS J. MARVEL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 NW COPPER OAKS CIR
BLUE SPRINGS MO
64015-8300
US

IV. Provider business mailing address

PO BOX 1628
BLUE SPRINGS MO
64013-1628
US

V. Phone/Fax

Practice location:
  • Phone: 816-224-6500
  • Fax: 816-224-2777
Mailing address:
  • Phone: 816-224-6500
  • Fax: 816-224-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002234
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: