Healthcare Provider Details

I. General information

NPI: 1700606753
Provider Name (Legal Business Name): COURTNEY LEIGH MILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2870
US

IV. Provider business mailing address

4721 S CLIFF AVE STE 103
INDEPENDENCE MO
64055-6969
US

V. Phone/Fax

Practice location:
  • Phone: 816-501-5138
  • Fax:
Mailing address:
  • Phone: 816-608-1956
  • Fax: 800-687-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-383484
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: