Provider Demographics
NPI:1720892011
Name:HUMMER, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HUMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8675 STATE ROUTE T
Mailing Address - Street 2:
Mailing Address - City:AMAZONIA
Mailing Address - State:MO
Mailing Address - Zip Code:64421-9104
Mailing Address - Country:US
Mailing Address - Phone:816-273-9664
Mailing Address - Fax:
Practice Address - Street 1:20 W 9TH ST STE 601
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1704
Practice Address - Country:US
Practice Address - Phone:816-287-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024032952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health