Provider Demographics
NPI:1578770954
Name:PERSONAL & FAMILY DEVELOPMENT SERVICES PTR
Entity Type:Organization
Organization Name:PERSONAL & FAMILY DEVELOPMENT SERVICES PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-756-0684
Mailing Address - Street 1:4400 BROADWAY ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-756-0684
Mailing Address - Fax:816-756-0604
Practice Address - Street 1:4400 BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-756-0684
Practice Address - Fax:816-756-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F520000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER