Healthcare Provider Details

I. General information

NPI: 1265786610
Provider Name (Legal Business Name): MRS. AMY LYNN DVORAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS AMY LYNN WHITE

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S INDEPENDENCE ST
HARRISONVILLE MO
64701-2352
US

IV. Provider business mailing address

1600 NW 66TH TER
KANSAS CITY MO
64118-2922
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-4010
  • Fax:
Mailing address:
  • Phone: 816-820-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: