Provider Demographics
NPI:1760946651
Name:REISS, ROBERT JOSEPH III (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:REISS
Suffix:III
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:JOSEPH
Other - Last Name:REISS
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:706 BROADWAY BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2306
Mailing Address - Country:US
Mailing Address - Phone:661-878-6234
Mailing Address - Fax:
Practice Address - Street 1:7381 W 133RD ST STE 260
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4750
Practice Address - Country:US
Practice Address - Phone:913-647-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health