Provider Demographics
NPI:1043990559
Name:TAFF, ETHAN (PLPC)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:TAFF
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 ROCKHILL RD APT 2423
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1185
Mailing Address - Country:US
Mailing Address - Phone:816-785-9228
Mailing Address - Fax:
Practice Address - Street 1:501 N SUNSET LN
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9402
Practice Address - Country:US
Practice Address - Phone:816-680-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023028229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health