Provider Demographics
NPI:1023179819
Name:GIERSCH, MARK STEPHEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:GIERSCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1383
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64069-1383
Mailing Address - Country:US
Mailing Address - Phone:816-509-9870
Mailing Address - Fax:816-368-0730
Practice Address - Street 1:1201 NW BRIARCLIFF PKWY FL 2
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1878
Practice Address - Country:US
Practice Address - Phone:816-694-7194
Practice Address - Fax:816-368-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000893101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620757OtherUNITED BEHAVIORAL HEALTH
MO17544017OtherBCBS OF KANSAS CITY
MO620757OtherUNITED BEHAVIORAL HEALTH