Healthcare Provider Details

I. General information

NPI: 1578479309
Provider Name (Legal Business Name): JEREMIAH R JUSTICE PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E COMMERCIAL ST
KAHOKA MO
63445-1710
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-1111
  • Fax: 660-727-1162
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026039922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: