Healthcare Provider Details

I. General information

NPI: 1285118943
Provider Name (Legal Business Name): LETICIA DUVIVIER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 63RD ST STE 202
KANSAS CITY MO
64113-1644
US

IV. Provider business mailing address

108 W 63RD ST UNIT 7029
KANSAS CITY MO
64113-3201
US

V. Phone/Fax

Practice location:
  • Phone: 816-623-2592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2018034241
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number19-10P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: