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General NPI Number Information
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NPI Number | 1154487411
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Entity Type | Individual
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Provider Name | TINA LOUISE RAMBO-FAULKNER LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 805 NE CAROUSEL LN
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City | LEES SUMMIT
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State | MO
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Zip | 64086-7039
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Country | US
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Telephone | 816-500-6223
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Fax |
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Provider Business Mailing Address
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Address Line | 4124 SW FLINTROCK DR
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City | LEES SUMMIT
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State | MO
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Zip | 64082-4869
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Country | US
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Telephone | 816-537-4145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2005030622
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License Number State | MO
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