Provider Demographics
NPI:1063496198
Name:RAGON, ROBERT TRAVIS (MS, MDIV, LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:TRAVIS
Last Name:RAGON
Suffix:
Gender:M
Credentials:MS, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SW ZZ HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64747
Mailing Address - Country:US
Mailing Address - Phone:816-554-9330
Mailing Address - Fax:816-554-0730
Practice Address - Street 1:4031 NE LAKEWOOD WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2060
Practice Address - Country:US
Practice Address - Phone:816-525-9889
Practice Address - Fax:816-554-0730
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002031OtherLICENSE NUMBER
MO498266204Medicaid