Provider Demographics
NPI:1629767819
Name:DEFOE, EMILY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:DEFOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 SE MILLER ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4241
Mailing Address - Country:US
Mailing Address - Phone:816-665-8586
Mailing Address - Fax:
Practice Address - Street 1:8340 MISSION RD STE 230
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1319
Practice Address - Country:US
Practice Address - Phone:913-735-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022045585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty