WUBBENHORST & WUBBENHORST, INC

Provider Demographics

• NPI: 1508110628
• Name: WUBBENHORST & WUBBENHORST, INC
• Entity Type: Organization
• Organization Name: WUBBENHORST & WUBBENHORST, INC
• Other - Org Name: MADISON AVENUE PSYCHOLOGICAL SERVICES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: JOHN
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: WUBBENHORST
• Authorized Official - Suffix: SR
• Authorized Official - Phone: 816-753-3333
• Mailing Address - Street 1: 3100 BROADWAY ST
• Mailing Address - Street 2: SUITE 1104
• Mailing Address - City: KANSAS CITY
• Mailing Address - State: MO
• Mailing Address - Zip Code: 64111-2658
• Mailing Address - Country: US
• Mailing Address - Phone: 816-753-3333
• Mailing Address - Fax: 816-753-7744
• Practice Address - Street 1: 12600 E 40 HWY
• Practice Address - Street 2: SUITE 101
• Practice Address - City: INDEPENDENCE
• Practice Address - State: MO
• Practice Address - Zip Code: 64055-5955
• Practice Address - Country: US
• Practice Address - Phone: 816-350-3333
• Practice Address - Fax: 816-478-8888
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2012-10-29
• Last Update Date: 2012-10-29

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	103TA0400X	Behavioral Health & Social Service Providers	Psychologist	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	103TA0700X	Behavioral Health & Social Service Providers	Psychologist	Adult Development & Aging	Group - Multi-Specialty
No	103TB0200X	Behavioral Health & Social Service Providers	Psychologist	Cognitive & Behavioral	Group - Multi-Specialty
No	103TC1900X	Behavioral Health & Social Service Providers	Psychologist	Counseling	Group - Multi-Specialty
No	103TC2200X	Behavioral Health & Social Service Providers	Psychologist	Clinical Child & Adolescent	Group - Multi-Specialty
No	103TP0814X	Behavioral Health & Social Service Providers	Psychologist	Psychoanalysis	Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty