Provider Demographics
NPI:1164458931
Name:DIAKONOS INC
Entity Type:Organization
Organization Name:DIAKONOS INC
Other - Org Name:DIAKONOS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-373-9240
Mailing Address - Street 1:4200 LITTLE BLUE PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8312
Mailing Address - Country:US
Mailing Address - Phone:816-373-9240
Mailing Address - Fax:816-373-9243
Practice Address - Street 1:4200 LITTLE BLUE PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8312
Practice Address - Country:US
Practice Address - Phone:816-373-9240
Practice Address - Fax:816-373-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0007690101YM0800X, 101YP1600X, 101YP2500X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS210000Medicare UPIN