Provider Demographics
NPI:1346682994
Name:BRIAN A FIDLER
Entity Type:Organization
Organization Name:BRIAN A FIDLER
Other - Org Name:EPIC COUNSELING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-622-3171
Mailing Address - Street 1:4200 LITTLE BLUE PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 LITTLE BLUE PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8312
Practice Address - Country:US
Practice Address - Phone:816-622-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPIC COUNSELING GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-24
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X, 103TC0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty