Healthcare Provider Details

I. General information

NPI: 1669617841
Provider Name (Legal Business Name): REJUVENATE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW LONGVIEW BLVD STE 160
LEES SUMMIT MO
64081-2112
US

IV. Provider business mailing address

400 SW LONGVIEW BLVD STE 160
LEES SUMMIT MO
64081-2112
US

V. Phone/Fax

Practice location:
  • Phone: 816-761-3944
  • Fax: 866-335-7993
Mailing address:
  • Phone: 816-761-3944
  • Fax: 866-335-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT J SYMES
Title or Position: OWNER
Credential: PSY D
Phone: 816-812-6820