Provider Demographics
NPI:1083937023
Name:M. ELIZABETH KINGSLEY, LLC
Entity Type:Organization
Organization Name:M. ELIZABETH KINGSLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-851-7780
Mailing Address - Street 1:7611 STATE LINE RD
Mailing Address - Street 2:STE. 226
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-6801
Mailing Address - Country:US
Mailing Address - Phone:816-753-7071
Mailing Address - Fax:816-926-9180
Practice Address - Street 1:7611 STATE LINE RD
Practice Address - Street 2:STE. 226
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-6801
Practice Address - Country:US
Practice Address - Phone:816-753-7071
Practice Address - Fax:816-926-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00281103T00000X
MO300045106H00000X
KS084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620005529OtherRAILROAD MEDICARE
MO493440218Medicaid
MO10212031OtherBCBS
MO0001837Medicare PIN