Healthcare Provider Details

I. General information

NPI: 1346842044
Provider Name (Legal Business Name): GRACE NGOZIKA OKONTA LPC, CRAADC, TTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BLUE PKWY BLDG C
KANSAS CITY MO
64130-2807
US

IV. Provider business mailing address

3801 BLUE PKWY BLDG C
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-599-5284
  • Fax:
Mailing address:
  • Phone: 816-599-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017011649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: