Healthcare Provider Details

I. General information

NPI: 1619968674
Provider Name (Legal Business Name): WUBBENHORST & WUBBENHORST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROADWAY ST STE 410
KANSAS CITY MO
64111-2506
US

IV. Provider business mailing address

3100 BROADWAY ST STE 410
KANSAS CITY MO
64111-2506
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-3333
  • Fax: 816-753-7744
Mailing address:
  • Phone: 816-753-3333
  • Fax: 816-753-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MICHAEL WUBBENHORST SR.
Title or Position: PRESIDENT OF CORPORATION
Credential: MS
Phone: 876-753-3333