Provider Demographics
NPI:1710362959
Name:CAREY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CAREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 NW 113TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-1891
Mailing Address - Country:US
Mailing Address - Phone:816-739-1603
Mailing Address - Fax:816-944-3224
Practice Address - Street 1:7280 NW 87TH TER STE 210
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3706
Practice Address - Country:US
Practice Address - Phone:816-944-3224
Practice Address - Fax:816-944-3224
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015043541101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid