Healthcare Provider Details

I. General information

NPI: 1356305999
Provider Name (Legal Business Name): EASTERN JACKSON COUNTY PSYCHIATRIC ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17221 E 23RD ST S #206
INDEPENDENCE MO
64057-1803
US

IV. Provider business mailing address

17221 E 23RD ST S #206
INDEPENDENCE MO
64057-1803
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-1911
  • Fax:
Mailing address:
  • Phone: 816-373-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA J KURTZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 816-373-1911