MEDICARE: MR. ROBERT TRAVIS RAGON M.S., M.DIV., L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	002031	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002031	OTHER	MO	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063496198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT TRAVIS RAGON M.S., M.DIV., L.P.C.

Provider Business Mailing Address
First Line	:	1044 SW ZZ HIGHWAY
Second Line	:
City	:	GARDEN CITY
State	:	MO
Zip	:	64747
Country	:	US
Telephone Number	:	816-554-9330
Fax Number	:	816-554-0730

Provider Business Practice Location Address
First Line	:	4031 NE LAKEWOOD WAY
Second Line	:	SUITE 100
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2060
Country	:	US
Telephone Number	:	816-525-9889
Fax Number	:	816-554-0730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	02/24/2012

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