Healthcare Provider Details

I. General information

NPI: 1831393719
Provider Name (Legal Business Name): RACHEL JUSTINE SIMEONE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 WORNALL RD
KANSAS CITY MO
64114-5806
US

IV. Provider business mailing address

217 W 51ST ST APARTMENT 1
KANSAS CITY MO
64112-2431
US

V. Phone/Fax

Practice location:
  • Phone: 816-508-3517
  • Fax: 816-508-3535
Mailing address:
  • Phone: 816-531-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006031503
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: