Provider Demographics
NPI:1326759150
Name:STARBOARD THERAPY AND COACHING
Entity Type:Organization
Organization Name:STARBOARD THERAPY AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-659-3202
Mailing Address - Street 1:107 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1705
Mailing Address - Country:US
Mailing Address - Phone:816-659-3202
Mailing Address - Fax:
Practice Address - Street 1:107 W 9TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1705
Practice Address - Country:US
Practice Address - Phone:816-659-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1700169968Medicaid