Provider Demographics
NPI:1841476256
Name:BERKEL, LAVERNE A
Entity type:Individual
Prefix:DR
First Name:LAVERNE
Middle Name:A
Last Name:BERKEL
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 1:222 W GREGORY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1140
Mailing Address - Country:US
Mailing Address - Phone:816-361-0664
Mailing Address - Fax:816-361-0677
Practice Address - Street 1:222 W GREGORY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1140
Practice Address - Country:US
Practice Address - Phone:816-361-0664
Practice Address - Fax:816-361-0677
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024162103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1841476256Medicare PIN