MEDICARE: DR. DANIEL RICHARD FECHT PHD

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	103T00000X	Psychologist	00368	MO
2	103TC1900X	Counseling Psychologist	00368	MO
3	103TH0100X	Health Service Psychologist	00368	MO

General Provider Information

NPI Number	:	1790769719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RICHARD FECHT PHD

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

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	01/12/2010

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