| Mind Shield and Sword Therapy, LLC | |
|
905 Ne Rice Rd Ste B Lees Summit MO 64086-6300 | |
| (816) 223-8522 | |
| Not Available |
| Full Name | Mind Shield and Sword Therapy, LLC |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 905 Ne Rice Rd Ste B, Lees Summit, Missouri |
| Authorized Official Name and Position | Dereik Lance Domerese (OWNER/MEMBER) |
| Authorized Official Contact | 8162238522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Shield and Sword Therapy, LLC 2410 Sw State Route 150 Lees Summit MO 64082-2903 Ph: (816) 223-8522 | Mind Shield and Sword Therapy, LLC 905 Ne Rice Rd Ste B Lees Summit MO 64086-6300 Ph: (816) 223-8522 |
| NPI Number | 1467181024 |
|---|---|
| Provider Enumeration Date | 06/08/2022 |
| Last Update Date | 06/15/2022 |
| Certification Date | 06/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467181024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (NU) | Secondary |
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
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