| Kansas City Therapy, Llc | |
|
4635 Wyandotte St Sutie 204 Kansas City MO 64112-1509 | |
| (816) 599-3918 | |
| Not Available |
| Full Name | Kansas City Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4635 Wyandotte St, Kansas City, Missouri |
| Authorized Official Name and Position | Bernadette Elena Borchardt (PSYCHOTHERAPY/MEMBER OF LLC) |
| Authorized Official Contact | 8164059985 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kansas City Therapy, Llc 4635 Wyandotte St Sutie 204 Kansas City MO 64112-1509 Ph: (816) 599-3918 | Kansas City Therapy, Llc 4635 Wyandotte St Sutie 204 Kansas City MO 64112-1509 Ph: (816) 599-3918 |
| NPI Number | 1467814376 |
|---|---|
| Provider Enumeration Date | 03/22/2016 |
| Last Update Date | 03/22/2016 |
| Medicare PECOS PAC ID | 8729379797 |
|---|---|
| Medicare Enrollment ID | O20160622000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467814376 | NPI | - | NPPES |
| 980336 | Other | MO | MISSOURI CARE |
| 1225304264 | Medicaid | MO | |
| PTAN #H74000010 | Other | MO | MEDICARE |
| 1649587148 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2013003118 (Missouri) | Primary |
| 1041C0700X | Social Worker - Clinical | 2011010746 (Missouri) | Secondary |
| Provider Name | Misty D Dixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225304264 PECOS PAC ID: 3971735010 Enrollment ID: I20140403002327 |
| Provider Name | Bernadette E Borchardt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649587148 PECOS PAC ID: 7719278795 Enrollment ID: I20160622001992 |
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