Provider Demographics
NPI:1154754794
Name:NORTHLAND PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Entity type:Organization
Organization Name:NORTHLAND PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BERTRAND
Authorized Official - Last Name:MURCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-436-0371
Mailing Address - Street 1:6812 N OAK TRFY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-2537
Mailing Address - Country:US
Mailing Address - Phone:816-436-0371
Mailing Address - Fax:816-436-0383
Practice Address - Street 1:6812 N OAK TRFY
Practice Address - Street 2:SUITE 1
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-2537
Practice Address - Country:US
Practice Address - Phone:816-436-0371
Practice Address - Fax:816-436-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013004423261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health