| Wise Mind Therapy Services, Llc | |
|
217 E 63rd St Kansas City MO 64113-2224 | |
| (816) 822-0200 | |
| (816) 444-6425 |
| Full Name | Wise Mind Therapy Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 217 E 63rd St, Kansas City, Missouri |
| Authorized Official Name and Position | Mark Thomas Mcgonigle (MANAGER) |
| Authorized Official Contact | 8168220200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wise Mind Therapy Services, Llc 217 E 63rd St Kansas City MO 64113-2224 Ph: (816) 822-0200 | Wise Mind Therapy Services, Llc 217 E 63rd St Kansas City MO 64113-2224 Ph: (816) 822-0200 |
| NPI Number | 1700041852 |
|---|---|
| Provider Enumeration Date | 07/28/2008 |
| Last Update Date | 07/28/2008 |
| Medicare PECOS PAC ID | 8729154281 |
|---|---|
| Medicare Enrollment ID | O20080906000023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700041852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2003019074 (Missouri) | Primary |
| Provider Name | Mark Thomas Mcgonigle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689616559 PECOS PAC ID: 4688646888 Enrollment ID: I20040809000939 |
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