Provider Demographics
NPI:1437393071
Name:HUCKABY, MARY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7611 STATE LINE RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-6801
Mailing Address - Country:US
Mailing Address - Phone:816-753-7071
Mailing Address - Fax:816-926-9180
Practice Address - Street 1:300 SE 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2759
Practice Address - Country:US
Practice Address - Phone:816-404-6170
Practice Address - Fax:816-525-2251
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022758101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499381705Medicaid