Healthcare Provider Details

I. General information

NPI: 1194978247
Provider Name (Legal Business Name): R B SHONKWILER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2008
Last Update Date: 11/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 EWING AVE
GRANDVIEW MO
64030-2055
US

IV. Provider business mailing address

12735 EWING AVE
GRANDVIEW MO
64030-2055
US

V. Phone/Fax

Practice location:
  • Phone: 816-304-7793
  • Fax:
Mailing address:
  • Phone: 816-304-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2007035389
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2007035389
License Number StateMO

VIII. Authorized Official

Name: MR. ROBERT B SHONKWILER
Title or Position: DIRECTOR OF COUNSELING SERVICES
Credential: LPC
Phone: 816-304-7793