Provider Demographics
NPI:1336837061
Name:ALIVE FAMILY PSYCHIATRY
Entity Type:Organization
Organization Name:ALIVE FAMILY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:816-845-8550
Mailing Address - Street 1:3515 S 4TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5079
Mailing Address - Country:US
Mailing Address - Phone:816-845-8550
Mailing Address - Fax:
Practice Address - Street 1:3515 S 4TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5079
Practice Address - Country:US
Practice Address - Phone:816-845-8550
Practice Address - Fax:949-440-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty