MEDICARE: SONYA K NISPEL, LPC, PC

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	101YM0800X	Mental Health Counselor	2008003866	MO

General Provider Information

NPI Number	:	1558607234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONYA K NISPEL, LPC, PC

Provider Business Mailing Address
First Line	:	656 SE BAYBERRY LN
Second Line	:	SUITE 105
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-4301
Country	:	US
Telephone Number	:	816-524-5572
Fax Number	:	816-298-1450

Provider Business Practice Location Address
First Line	:	656 SE BAYBERRY LN
Second Line	:	SUITE 105
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-4301
Country	:	US
Telephone Number	:	816-524-5572
Fax Number	:	816-298-1450

Authorized Official
Title or Position	:	OWNER
Name	:	SONYA K NISPEL
Credential	:	LPC
Telephone Number	:	816-524-5572

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	12/27/2012

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