Provider Demographics
NPI:1699348490
Name:PRICE, BRANDON (MDIV, LMSW)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:MDIV, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2110
Mailing Address - Country:US
Mailing Address - Phone:804-840-3550
Mailing Address - Fax:
Practice Address - Street 1:2708 W 43RD AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-3125
Practice Address - Country:US
Practice Address - Phone:913-708-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health