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General NPI Number Information
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NPI Number | 1417033895
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Entity Type | Individual
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Provider Name | JASON CARTER FAIRMAN PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2006
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 2900 SW 13TH ST
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City | LEES SUMMIT
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State | MO
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Zip | 64081-3800
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Country | US
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Telephone | 816-516-7114
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Fax | 816-437-7399
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Provider Business Mailing Address
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Address Line | 2900 SW 13TH ST
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City | LEES SUMMIT
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State | MO
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Zip | 64081-3800
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Country | US
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Telephone | 816-516-7114
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Fax | 816-437-7399
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2004033756
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License Number State | MO
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