Provider Demographics
NPI:1083896575
Name:BREWER, KATHRYN J (PHD, LPC, LCPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:J
Last Name:BREWER
Suffix:
Gender:F
Credentials:PHD, LPC, LCPC, NCC
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 481372
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64148-1372
Mailing Address - Country:US
Mailing Address - Phone:816-569-1043
Mailing Address - Fax:
Practice Address - Street 1:4240 BLUE RIDGE BLVD STE 530
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1713
Practice Address - Country:US
Practice Address - Phone:816-569-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497598003Medicaid