Provider Demographics
NPI:1235517863
Name:SANDRA TOMPKINS, LCSW, LLC
Entity Type:Organization
Organization Name:SANDRA TOMPKINS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-588-2836
Mailing Address - Street 1:1404 N GLEN ELLYN ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-1329
Mailing Address - Country:US
Mailing Address - Phone:816-588-2836
Mailing Address - Fax:
Practice Address - Street 1:656 SE BAYBERRY LN
Practice Address - Street 2:SUITE 105
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4301
Practice Address - Country:US
Practice Address - Phone:816-588-2836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPTAN H47000008Medicare UPIN