Healthcare Provider Details

I. General information

NPI: 1669339495
Provider Name (Legal Business Name): MICHAELA TOLLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA TOLLIVER-BRIMHALL

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 S CLIFF AVE STE 200
INDEPENDENCE MO
64055-6969
US

IV. Provider business mailing address

18800 E R D MIZE RD
INDEPENDENCE MO
64057-1743
US

V. Phone/Fax

Practice location:
  • Phone: 816-476-1725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: