Provider Demographics
NPI:1760972517
Name:DOMINICK SCALISE PHD LLC
Entity Type:Organization
Organization Name:DOMINICK SCALISE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-360-9221
Mailing Address - Street 1:15184 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2366
Mailing Address - Country:US
Mailing Address - Phone:573-680-1671
Mailing Address - Fax:
Practice Address - Street 1:511 N MUR LEN RD STE A
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1208
Practice Address - Country:US
Practice Address - Phone:816-360-9221
Practice Address - Fax:800-207-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty