Provider Demographics
NPI:1164701546
Name:EISENREICH, PAMELA SUE (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:EISENREICH
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 NE VIVION RD STE 204
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2800
Mailing Address - Country:US
Mailing Address - Phone:816-800-9246
Mailing Address - Fax:816-663-9921
Practice Address - Street 1:4401 NE VIVION RD STE 204
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2800
Practice Address - Country:US
Practice Address - Phone:816-800-9246
Practice Address - Fax:816-663-9921
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1851150783OtherGROUP NPI