Healthcare Provider Details

I. General information

NPI: 1578785358
Provider Name (Legal Business Name): WEBER PAHLA INGERSOLL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 TROOST AVE RM. 206
KANSAS CITY MO
64110-2030
US

IV. Provider business mailing address

4825 TROOST AVE RM. 206
KANSAS CITY MO
64110-2030
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-5185
  • Fax:
Mailing address:
  • Phone: 816-235-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 01477
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: