1689769150 NPI number — MR. MARK REDMOND MCCARTHY LPC

Table of content: MR. MARK REDMOND MCCARTHY LPC (NPI 1689769150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689769150 NPI number — MR. MARK REDMOND MCCARTHY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
MARK
Provider Middle Name:
REDMOND
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689769150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-931-0011
Provider Business Mailing Address Fax Number:
816-531-7740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-931-0011
Provider Business Practice Location Address Fax Number:
816-531-7740
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  CS001386 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: CS001386 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MO CS001386 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com