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General NPI Number Information
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NPI Number | 1093425274
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Entity Type | Organization
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Legal Business Name | INIQUITORIA LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 117 S LEXINGTON ST STE 100
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City | HARRISONVILLE
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State | MO
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Zip | 64701-2444
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Country | US
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Telephone | 913-608-2021
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 480303
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City | KANSAS CITY
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State | MO
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Zip | 64148-0303
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Country | US
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Telephone | 913-608-2021
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Fax |
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Authorized Official
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Title or Position | JUNGIAN ANALYST
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Name | MR. ANDREW SHERWOOD
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Credential | LCSW
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Telephone | 913-608-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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