Healthcare Provider Details

I. General information

NPI: 1023242948
Provider Name (Legal Business Name): PRECIOUS STONES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W 132ND ST
KANSAS CITY MO
64145-1267
US

IV. Provider business mailing address

10 W 132ND ST
KANSAS CITY MO
64145-1267
US

V. Phone/Fax

Practice location:
  • Phone: 816-678-4830
  • Fax:
Mailing address:
  • Phone: 816-678-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number1521779
License Number StateMO

VIII. Authorized Official

Name: MR. NATHAN WARREN CARLSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 816-665-4474