=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720892011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CODY HUMMER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2025
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 W 9TH ST STE 601
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64105-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-287-0337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8675 STATE ROUTE T
-----------------------------------------------------
City | AMAZONIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64421-9104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-273-9664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2024032952
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------