Provider Demographics
NPI:1407874753
Name:CONNELLY, MARK ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:4TH FLOOR, DEVELOPMENTAL AND BEHAVIORAL SCIENCES
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3193
Mailing Address - Fax:816-346-1382
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:4TH FLOOR, DEVELOPMENTAL AND BEHAVIORAL SCIENCES
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3193
Practice Address - Fax:816-460-1080
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006016149103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist