Healthcare Provider Details

I. General information

NPI: 1235517863
Provider Name (Legal Business Name): SANDRA TOMPKINS, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 SE BAYBERRY LN SUITE 105
LEES SUMMIT MO
64063-4301
US

IV. Provider business mailing address

1404 N GLEN ELLYN ST
INDEPENDENCE MO
64056-1329
US

V. Phone/Fax

Practice location:
  • Phone: 816-588-2836
  • Fax:
Mailing address:
  • Phone: 816-588-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SANDRA L TOMPKINS
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 816-588-2836