Provider Demographics
NPI:1417004482
Name:KABAT, SYRTILLER M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SYRTILLER
Middle Name:M
Last Name:KABAT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SE INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2854
Mailing Address - Country:US
Mailing Address - Phone:816-524-5257
Mailing Address - Fax:816-554-2448
Practice Address - Street 1:410 SE INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2854
Practice Address - Country:US
Practice Address - Phone:816-524-5257
Practice Address - Fax:816-554-2448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO300082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist