Healthcare Provider Details

I. General information

NPI: 1477498764
Provider Name (Legal Business Name): JEEVANBA PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 E 62ND ST
KANSAS CITY MO
64110-3381
US

IV. Provider business mailing address

731 E 62ND ST
KANSAS CITY MO
64110-3381
US

V. Phone/Fax

Practice location:
  • Phone: 816-974-3965
  • Fax:
Mailing address:
  • Phone: 816-974-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SATHYA BAANU JEEVANBA
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 816-905-8936