Provider Demographics
NPI:1396294021
Name:SLAY, BRE-ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRE-ANN
Middle Name:
Last Name:SLAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 BROOKSIDE PLZ STE 227
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1709
Mailing Address - Country:US
Mailing Address - Phone:816-200-1513
Mailing Address - Fax:
Practice Address - Street 1:300 SE 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2759
Practice Address - Country:US
Practice Address - Phone:816-404-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MOMO2021021975103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490101303Medicaid