Healthcare Provider Details

I. General information

NPI: 1366035875
Provider Name (Legal Business Name): LAKEWOOD PSYCHOLOGICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 NE LA COSTA ST
LEES SUMMIT MO
64064-1359
US

IV. Provider business mailing address

709 NE LA COSTA ST
LEES SUMMIT MO
64064-1359
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 TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY CARL MORRISON
Title or Position: OWNER
Credential: PH.D.
Phone: 816-516-4039