| Mark Smith, Professional Services, Llc | |
|
14825 E 42nd St S Suite 208 Independence MO 64055-4776 | |
| (816) 353-5363 | |
| (816) 295-6100 |
| Full Name | Mark Smith, Professional Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14825 E 42nd St S, Independence, Missouri |
| Authorized Official Name and Position | Mark Leslie Smith (OWNER) |
| Authorized Official Contact | 8163535363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Smith, Professional Services, Llc 14825 E 42nd St S Suite 208 Independence MO 64055-4776 Ph: (816) 353-5363 | Mark Smith, Professional Services, Llc 14825 E 42nd St S Suite 208 Independence MO 64055-4776 Ph: (816) 353-5363 |
| NPI Number | 1669617627 |
|---|---|
| Provider Enumeration Date | 12/04/2008 |
| Last Update Date | 05/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669617627 | NPI | - | NPPES |
| 493295521 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 002326 (Missouri) | Primary |
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