Healthcare Provider Details

I. General information

NPI: 1003112889
Provider Name (Legal Business Name): VIVICA YVONNE SNYPE-STEWART LPC, LMSW, CRC, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIVICA YVONNE SNYPE-STEWART LPC,CRC, LMSW, LCAC

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CHERRY ST
KANSAS CITY MO
64108-1530
US

IV. Provider business mailing address

1520 CHERRY ST
KANSAS CITY MO
64108-1530
US

V. Phone/Fax

Practice location:
  • Phone: 816-421-7643
  • Fax: 816-421-0405
Mailing address:
  • Phone: 816-421-7643
  • Fax: 816-421-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7733
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number961
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number219
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: