| Northland Behavioral Health & Wellness, Llc | |
|
119 Ne 72nd St Gladstone MO 64118-1826 | |
| (816) 420-3130 | |
| (816) 734-0083 |
| Full Name | Northland Behavioral Health & Wellness, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 119 Ne 72nd St, Gladstone, Missouri |
| Authorized Official Name and Position | Amy M Shoffner (PSYCHOLOGIST) |
| Authorized Official Contact | 8164203130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northland Behavioral Health & Wellness, Llc 119 Ne 72nd St Gladstone MO 64118-1826 Ph: (816) 420-3130 | Northland Behavioral Health & Wellness, Llc 119 Ne 72nd St Gladstone MO 64118-1826 Ph: (816) 420-3130 |
| NPI Number | 1750615829 |
|---|---|
| Provider Enumeration Date | 09/23/2009 |
| Last Update Date | 09/23/2009 |
| Medicare PECOS PAC ID | 4486790094 |
|---|---|
| Medicare Enrollment ID | O20091013000562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750615829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 2005004519 (Missouri) | Primary |
| Provider Name | Amy Marie Shoffner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225139553 PECOS PAC ID: 7911915004 Enrollment ID: I20061208000503 |
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