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General NPI Number Information
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NPI Number | 1053187716
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Entity Type | Organization
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Legal Business Name | NEURODIVERSITY CLINIC LLC
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 4963 NE GOODVIEW CIR STE C
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2491
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Country | US
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Telephone | 816-516-4039
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Fax |
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Provider Business Mailing Address
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Address Line | 4963 NE GOODVIEW CIR STE C
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2491
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Country | US
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Telephone | 816-516-4039
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANTHONY MORRISON
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Credential | PH.D.
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Telephone | 816-379-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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