Healthcare Provider Details

I. General information

NPI: 1801536131
Provider Name (Legal Business Name): KRISTEN SHANNA OHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N WATER ST STE 1
LIBERTY MO
64068-1747
US

IV. Provider business mailing address

608 NORTHPOINT AVE
LIBERTY MO
64068-1276
US

V. Phone/Fax

Practice location:
  • Phone: 550-348-4816
  • Fax:
Mailing address:
  • Phone: 816-838-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2021048320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: