Provider Demographics
NPI:1750635603
Name:MATHIS, MIRANDA (LMSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:100 WESTWOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1181
Mailing Address - Country:US
Mailing Address - Phone:816-781-8550
Mailing Address - Fax:816-792-3219
Practice Address - Street 1:5800 FOX RIDGE DRIVE
Practice Address - Street 2:SUITE 420
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2357
Practice Address - Country:US
Practice Address - Phone:816-781-8550
Practice Address - Fax:816-792-3219
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker