Healthcare Provider Details

I. General information

NPI: 1619813441
Provider Name (Legal Business Name): DANIELLE NICOLE LAVARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E 63RD ST STE 212
KANSAS CITY MO
64110-3372
US

IV. Provider business mailing address

3600 BROADWAY BLVD APT 536
KANSAS CITY MO
64111-5621
US

V. Phone/Fax

Practice location:
  • Phone: 816-296-6551
  • Fax:
Mailing address:
  • Phone: 816-965-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026014075
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: