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General NPI Number Information
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NPI Number | 1528148269
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Entity Type | Organization
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Legal Business Name | ACADEMY FOR COUNSELING & CHANGE LTD
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 CARONDELET DRIVE SUITE 405
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City | KANSAS CITY
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State | MO
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Zip | 64114
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Country | US
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Telephone | 816-968-9660
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Fax | 816-941-3802
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Provider Business Mailing Address
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Address Line | 1010 CARONDELET DRIVE SUITE 405
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City | KANSAS CITY
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State | MO
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Zip | 64114
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Country | US
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Telephone | 816-968-9660
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Fax | 816-941-3802
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Authorized Official
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Title or Position | PRESIDENT DIRECTOR
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Name | DR. FREDERICK DANIEL GROSSMAN
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Credential | PHD
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Telephone | 816-968-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY00897
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License Number State | MO
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