Provider Demographics
NPI:1992800395
Name:ELIZABETH HUNTER-BLANK, LLC
Entity type:Organization
Organization Name:ELIZABETH HUNTER-BLANK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LEONA
Authorized Official - Last Name:HUNTER-BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LSCSW
Authorized Official - Phone:816-582-3877
Mailing Address - Street 1:4104 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2307
Mailing Address - Country:US
Mailing Address - Phone:816-582-3877
Mailing Address - Fax:913-362-5597
Practice Address - Street 1:4104 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2307
Practice Address - Country:US
Practice Address - Phone:816-582-3877
Practice Address - Fax:913-362-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991353821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494763600Medicaid