Provider Demographics
NPI:1316044639
Name:LANDSBERG, DEAN ARNOLD (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:ARNOLD
Last Name:LANDSBERG
Suffix:
Gender:M
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 N PARK
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64018
Mailing Address - Country:US
Mailing Address - Phone:816-436-1137
Mailing Address - Fax:816-373-7621
Practice Address - Street 1:4201 S HOCKER DR STE B2
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4763
Practice Address - Country:US
Practice Address - Phone:816-373-7878
Practice Address - Fax:816-373-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100719OtherMHN
MO07185014OtherBLUECROSS/BLUESHIELD
MO6143117OtherUBH
KS613317OtherKS BLUECROSS
MOS59878OtherVALUE OPTIONS
MO4343682OtherMAGELLAN
MO100719OtherMHN
MO0008172Medicare ID - Type UnspecifiedMEDICAREB