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General NPI Number Information
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NPI Number | 1366035875
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Entity Type | Organization
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Legal Business Name | LAKEWOOD PSYCHOLOGICAL SERVICES P.C.
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 709 NE LA COSTA ST
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1359
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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 | 709 NE LA COSTA ST
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1359
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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 | OWNER
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Name | ANTHONY CARL MORRISON
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Credential | PH.D.
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Telephone | 816-516-4039
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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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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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