Provider Demographics
NPI:1972811578
Name:PEP PHYSICAL & EMOTIONAL POWER FOR LIFE, LLC
Entity Type:Organization
Organization Name:PEP PHYSICAL & EMOTIONAL POWER FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITEL
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LCSW
Authorized Official - Phone:816-872-2463
Mailing Address - Street 1:7280 NW 87TH TER
Mailing Address - Street 2:#210
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-3720
Mailing Address - Country:US
Mailing Address - Phone:816-872-2463
Mailing Address - Fax:816-533-7220
Practice Address - Street 1:7280 NW 87TH TER
Practice Address - Street 2:#210
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3720
Practice Address - Country:US
Practice Address - Phone:816-872-2463
Practice Address - Fax:816-533-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003022197251S00000X
KS2387251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health