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General NPI Number Information
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NPI Number | 1093209124
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Entity Type | Organization
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Legal Business Name | RESTORATIVE BRAIN CLINIC, INC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1010 CARONDELET DR STE 112
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City | KANSAS CITY
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State | MO
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Zip | 64114-4821
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Country | US
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Telephone | 866-695-2867
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Fax | 816-321-1107
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Provider Business Mailing Address
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Address Line | 1010 CARONDELET DR STE 112
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City | KANSAS CITY
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State | MO
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Zip | 64114-4821
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Country | US
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Telephone | 866-695-2867
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Fax | 816-321-1107
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JAMIE N DAVIS
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Credential | RN
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Telephone | 816-738-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | MO
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