Healthcare Provider Details

I. General information

NPI: 1417072026
Provider Name (Legal Business Name): MICHAEL JOE POLLOCK M.A., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 WARD PKWY SUITE 230
KANSAS CITY MO
64114-2034
US

IV. Provider business mailing address

8080 WARD PKWY SUITE 230
KANSAS CITY MO
64114-2034
US

V. Phone/Fax

Practice location:
  • Phone: 816-822-1922
  • Fax: 816-822-2248
Mailing address:
  • Phone: 816-822-1922
  • Fax: 816-822-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY01767
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY01767
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: