=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831276864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE A PRATT MED LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8120 N COSBY AVE
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64151-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-805-4287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 260
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64051-0260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-254-3652
-----------------------------------------------------
Fax | 816-254-9243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2002032327
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------