MEDICARE: AMY MARIE TIBBITTS LCSW

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	2000174524	MO
2	101YM0800X	Mental Health Counselor	2007	KS

General Provider Information

NPI Number	:	1841349933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE TIBBITTS LCSW

Provider Business Mailing Address
First Line	:	2029 BUCHANAN ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3405
Country	:	US
Telephone Number	:	816-221-0305
Fax Number	:	816-221-9121

Provider Business Practice Location Address
First Line	:	2029 BUCHANAN ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3405
Country	:	US
Telephone Number	:	816-221-0305
Fax Number	:	816-221-9121

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/13/2021

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