Healthcare Provider Details

I. General information

NPI: 1417871815
Provider Name (Legal Business Name): KELLY KNETTER CHAMBERLAIN S-MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NW SOUTH OUTER RD STE 225
BLUE SPRINGS MO
64015-3051
US

IV. Provider business mailing address

129 SW 26TH STREET CT
BLUE SPRINGS MO
64015-3341
US

V. Phone/Fax

Practice location:
  • Phone: 816-434-0380
  • Fax:
Mailing address:
  • Phone: 913-439-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: