Healthcare Provider Details

I. General information

NPI: 1306977426
Provider Name (Legal Business Name): BRUCE K. MANLEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 N SAINT CLAIR AVE SUITE 250
KANSAS CITY MO
64151-5100
US

IV. Provider business mailing address

5411 NW EDGEWOOD TRL
KANSAS CITY MO
64151-3393
US

V. Phone/Fax

Practice location:
  • Phone: 816-223-6128
  • Fax:
Mailing address:
  • Phone: 816-223-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2001003634
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP-0999
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2001003634
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: