Healthcare Provider Details

I. General information

NPI: 1134310154
Provider Name (Legal Business Name): OTHMER PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 NW 64TH TER
KANSAS CITY MO
64151-2382
US

IV. Provider business mailing address

5709 NW 64TH TER
KANSAS CITY MO
64151-2382
US

V. Phone/Fax

Practice location:
  • Phone: 816-746-5555
  • Fax: 816-746-5996
Mailing address:
  • Phone: 816-746-5555
  • Fax: 816-746-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1473
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003750
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2005021811
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2005027490
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33862
License Number StateMO

VIII. Authorized Official

Name: MRS. SIEGLINDE C OTHMER
Title or Position: OWNER
Credential:
Phone: 816-746-5555