Healthcare Provider Details

I. General information

NPI: 1982520904
Provider Name (Legal Business Name): SAMAR M WAHBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET DR STE 405
KANSAS CITY MO
64114-4824
US

IV. Provider business mailing address

8009 W 113TH TER
OVERLAND PARK KS
66210-1812
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-0145
  • Fax:
Mailing address:
  • Phone: 913-710-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024034681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: