Healthcare Provider Details

I. General information

NPI: 1336006428
Provider Name (Legal Business Name): STACEY ANDERSON OBRIEN LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SW JEFFERSON ST STE 206
LEES SUMMIT MO
64063-3988
US

IV. Provider business mailing address

600 SW JEFFERSON ST STE 206
LEES SUMMIT MO
64063-3988
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-7705
  • Fax: 816-554-7706
Mailing address:
  • Phone: 816-554-7705
  • Fax: 816-554-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025028646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: