MEDICARE: LIZ DAVIS THERAPY

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
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1578438057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIZ DAVIS THERAPY

Provider Business Mailing Address
First Line	:	4116 BALTIMORE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2303
Country	:	US
Telephone Number	:	913-346-4768
Fax Number	:

Provider Business Practice Location Address
First Line	:	4116 BALTIMORE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2303
Country	:	US
Telephone Number	:	913-346-4768
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. PETER SOTO
Credential	:
Telephone Number	:	913-346-4768

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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Directions to “LIZ DAVIS THERAPY ” Practice Location

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