Healthcare Provider Details

I. General information

NPI: 1053187716
Provider Name (Legal Business Name): NEURODIVERSITY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4963 NE GOODVIEW CIR STE C
LEES SUMMIT MO
64064-2491
US

IV. Provider business mailing address

4963 NE GOODVIEW CIR STE C
LEES SUMMIT MO
64064-2491
US

V. Phone/Fax

Practice location:
  • Phone: 816-516-4039
  • Fax:
Mailing address:
  • Phone: 816-516-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MORRISON
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 816-379-4050