Healthcare Provider Details

I. General information

NPI: 1841994050
Provider Name (Legal Business Name): MENTALLY FREE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAIN ST
KANSAS CITY MO
64105-2120
US

IV. Provider business mailing address

120 W TRINITY PL
DECATUR GA
30030-3313
US

V. Phone/Fax

Practice location:
  • Phone: 470-944-5699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANTISSA CLAPP
Title or Position: OWNER
Credential:
Phone: 816-372-5279