| Plaza Therapy Group Llc | |
|
4635 Wyandotte St Suite 205 Kansas City MO 64112-1509 | |
| (917) 664-6530 | |
| Not Available |
| Full Name | Plaza Therapy Group Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4635 Wyandotte St, Kansas City, Missouri |
| Authorized Official Name and Position | Kelli Lynn Wiethan (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 9176646530 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Plaza Therapy Group Llc 4635 Wyandotte St Suite 205 Kansas City MO 64112-1509 Ph: (917) 664-6530 | Plaza Therapy Group Llc 4635 Wyandotte St Suite 205 Kansas City MO 64112-1509 Ph: (917) 664-6530 |
| NPI Number | 1598290074 |
|---|---|
| Provider Enumeration Date | 04/21/2017 |
| Last Update Date | 04/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598290074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2008033440 (Missouri) | Primary |
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