Provider Demographics
NPI:1205043205
Name:PERSONAL AND FAMILY DEVELOPMENT ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PERSONAL AND FAMILY DEVELOPMENT ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-756-0684
Mailing Address - Street 1:4400 BROADWAY ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-756-0684
Mailing Address - Fax:816-756-0604
Practice Address - Street 1:4400 BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-756-0684
Practice Address - Fax:816-756-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00112103TC0700X
KS0441103TC0700X
MOSW0029671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty