Healthcare Provider Details

I. General information

NPI: 1457070054
Provider Name (Legal Business Name): ELISABETH DOROTHY KLEMME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIS KLEMME

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 NE TROON DR
LEES SUMMIT MO
64064-1988
US

IV. Provider business mailing address

PO BOX 844383
DALLAS TX
75284-4383
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-0305
  • Fax: 816-221-9121
Mailing address:
  • Phone: 816-221-0305
  • Fax: 816-221-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026029940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: