Provider Demographics
NPI:1619968674
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 OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WUBBENHORST
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS
Authorized Official - Phone:876-753-3333
Mailing Address - Street 1:3100 BROADWAY ST
Mailing Address - Street 2:STE 410
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2506
Mailing Address - Country:US
Mailing Address - Phone:816-753-3333
Mailing Address - Fax:816-753-7744
Practice Address - Street 1:3100 BROADWAY ST
Practice Address - Street 2:STE 410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2506
Practice Address - Country:US
Practice Address - Phone:816-753-3333
Practice Address - Fax:816-753-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty