Provider Demographics
NPI:1497220842
Name:STYLES, MARIE S
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:S
Last Name:STYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-0577
Mailing Address - Country:US
Mailing Address - Phone:816-875-6868
Mailing Address - Fax:816-875-4199
Practice Address - Street 1:4801 S CLIFF AVE STE 214A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7015
Practice Address - Country:US
Practice Address - Phone:816-867-6868
Practice Address - Fax:816-875-4199
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018019025104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1497220842Medicaid