Healthcare Provider Details

I. General information

NPI: 1912033069
Provider Name (Legal Business Name): MARITA BARKIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WARD PKWY SUITE 107
KANSAS CITY MO
64112-2106
US

IV. Provider business mailing address

4825 TROOST AVE SUITE 206
KANSAS CITY MO
64110-2030
US

V. Phone/Fax

Practice location:
  • Phone: 816-756-1722
  • Fax: 816-756-1533
Mailing address:
  • Phone: 816-235-1219
  • Fax: 816-235-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1374
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0734
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0018
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: