Doctor Name: | MARK A KASSEBAUM |
NPI Number: | 1447509948 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 2007004366 |
Business Practice Address: | 1091 Midway Dr Linn Creek, MO - 650521687 |
Business Phone Number: | 5733466758 |
Business Fax Number: | 5733460621 |
Mailing Address: | 1091 Midway Dr, LINN CREEK |
State: | MO |
Postal Code: | 650521687 |
Phone Number: | 5733466758 |
Fax Number: | 5733460621 |
NPI Enumeration Date: | 08/30/2012 |
NPI Last Update Date: | 08/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 2007004366 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |