Healthcare Provider Details

I. General information

NPI: 1013736206
Provider Name (Legal Business Name): LINDSAY KOBOLT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E RED BRIDGE RD
KANSAS CITY MO
64131-4035
US

IV. Provider business mailing address

12 W 69TH TER
KANSAS CITY MO
64113-2540
US

V. Phone/Fax

Practice location:
  • Phone: 816-935-5907
  • Fax:
Mailing address:
  • Phone: 816-935-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2008036891
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: