Provider Demographics
NPI:1689616559
Name:MCGONIGLE, MARK THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:MCGONIGLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:222 W GREGORY BLVD
Mailing Address - Street 2:STE 310
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1127
Mailing Address - Country:US
Mailing Address - Phone:816-822-0200
Mailing Address - Fax:816-895-5210
Practice Address - Street 1:217 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2224
Practice Address - Country:US
Practice Address - Phone:816-822-0200
Practice Address - Fax:816-444-6425
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030190741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical