Provider Demographics
NPI:1215995790
Name:SIDNEY, LARRY E (MA, LPC, NCC, LCSW)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:E
Last Name:SIDNEY
Suffix:
Gender:M
Credentials:MA, LPC, NCC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 WINSLOW PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3269
Mailing Address - Country:US
Mailing Address - Phone:816-942-5555
Mailing Address - Fax:
Practice Address - Street 1:3101 BROADWAY ST
Practice Address - Street 2:SUITE 230
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2659
Practice Address - Country:US
Practice Address - Phone:816-531-2900
Practice Address - Fax:816-531-2901
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000729101YP2500X
MO0038781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO127826OtherNEW DIRECTIONS BEHAVIORAL
MO28784029OtherBLUECROSS BLUE SHIELDS