Provider Demographics
NPI:1063027902
Name:BABILON, SALOME AVERI (PLPC)
Entity Type:Individual
Prefix:
First Name:SALOME
Middle Name:AVERI
Last Name:BABILON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 S COACHMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4040
Mailing Address - Country:US
Mailing Address - Phone:816-905-4136
Mailing Address - Fax:
Practice Address - Street 1:105C W WALL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2355
Practice Address - Country:US
Practice Address - Phone:816-974-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health