MEDICARE: PARKVILLE PSYCHIATRY LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1265328744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKVILLE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	6300 N REVERE DR STE 255
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-3918
Country	:	US
Telephone Number	:	816-744-6145
Fax Number	:	816-647-0424

Provider Business Practice Location Address
First Line	:	6300 N REVERE DR STE 255
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-3918
Country	:	US
Telephone Number	:	816-744-6145
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THALIA TUCCI
Credential	:
Telephone Number	:	816-744-6145

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	01/21/2026

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