Healthcare Provider Details

I. General information

NPI: 1437536323
Provider Name (Legal Business Name): JASON HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 6TH ST
PARKVILLE MO
64152-3703
US

IV. Provider business mailing address

400 E 6TH ST
PARKVILLE MO
64152-3703
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-4100
  • Fax: 816-587-6691
Mailing address:
  • Phone: 816-587-4100
  • Fax: 816-587-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2015012315
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: