Provider Demographics
NPI:1114210861
Name:WILBURN, KEVIN OWEN (MA, NCC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:OWEN
Last Name:WILBURN
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1135
Mailing Address - Country:US
Mailing Address - Phone:816-508-3493
Mailing Address - Fax:
Practice Address - Street 1:9700 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1135
Practice Address - Country:US
Practice Address - Phone:816-508-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor