MEDICARE: WUBBENHORST & WUBBENHORST, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	103T00000X	Psychologist
6	103TA0400X	Addiction (Substance Use Disorder) Psychologist
7	103TA0700X	Adult Development & Aging Psychologist
8	103TB0200X	Cognitive & Behavioral Psychologist
9	103TC1900X	Counseling Psychologist
10	103TC2200X	Clinical Child & Adolescent Psychologist
11	103TP0814X	Psychoanalysis Psychologist
12	104100000X	Social Worker
13	1041C0700X	Clinical Social Worker
14	106H00000X	Marriage & Family Therapist
15	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1467706481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WUBBENHORST & WUBBENHORST, INC.

Provider Business Mailing Address
First Line	:	3100 BROADWAY ST
Second Line	:	SUITE 1104
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2658
Country	:	US
Telephone Number	:	816-753-3333
Fax Number	:	816-753-7744

Provider Business Practice Location Address
First Line	:	1310 CARONDELET DR
Second Line	:	SUITE 430
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4800
Country	:	US
Telephone Number	:	816-941-3331
Fax Number	:	816-941-3338

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN M WUBBENHORST SR.
Credential	:
Telephone Number	:	816-753-3333

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	10/29/2012

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