Provider Demographics
NPI:1306977426
Name:MANLEY, BRUCE K (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:K
Last Name:MANLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 NW EDGEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3393
Mailing Address - Country:US
Mailing Address - Phone:816-223-6128
Mailing Address - Fax:
Practice Address - Street 1:8350 N SAINT CLAIR AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-5100
Practice Address - Country:US
Practice Address - Phone:816-223-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003634103T00000X, 103TH0100X
KSLP-0999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27031028OtherBLUE CROSS NON-PROVIDER #
MO27031028OtherBLUE CROSS NON-PROVIDER #