Provider Demographics
NPI:1861021669
Name:ANCONA, FRANK (MSW CRAADC,SQP)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:ANCONA
Suffix:
Gender:M
Credentials:MSW CRAADC,SQP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 SW LOIS LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4130
Mailing Address - Country:US
Mailing Address - Phone:816-547-7860
Mailing Address - Fax:
Practice Address - Street 1:1132 SW LUTTRELL RD STE F
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4900
Practice Address - Country:US
Practice Address - Phone:826-224-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1525OtherCRAADC MISSOURI
MO1524Medicaid
1524OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR