Unknown Individual – Psychologist, NPI 1164517389

Unknown Individual is a healthcare provider. based in Lees summit, Missouri. specializing in Psychologist. They hold a License No. 01316 (MO). The NPI Number for Unknown Individual is 1164517389

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164517389
Phone
(816) 886-2184
Address
4045 NE LAKEWOOD WAY STE 130
Deactivation Date
19 July 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8168862184
Graduation Year
1987 (39 years ago)
PAC ID
8729141510
Professional Enrollment ID
I20090105000449
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 4045 NE LAKEWOOD WAY STE 130

    LEES SUMMIT, MO 640641995

    Phone: (816) 886-2184

    Fax: (816) 886-2397

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 64064)

Loading plans...

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1164517389 when you need to reference Unknown Individual in forms, claims, or directories.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Psychologist. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Lees Summit, Missouri for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

Similar Providers

1808 NE BURGANDY CIR
NPI: 1942283478
709 NE LACOSTA STREET
NPI: 1245299056

Unknown Individual

Psychologist
409, Southeast Douglas Street, Lee's Summit, Jackson County, Missouri, 64063, United States
NPI: 1033125521
3524 NE LACEWOOD CIR
NPI: 1740290063
U Street, Lake Lotawana, Jackson County, Missouri, 64051, United States
NPI: 1215021068

DR. AMELIA R HARRIS (PSY D)

Clinical Psychologist
200, Northeast Missouri Road, Lee's Summit, Jackson County, Missouri, 64086, United States
NPI: 1881782779
2900, Southwest 13th Street, Longview Farm, Lee's Summit, Jackson County, Missouri, 64081, United States
NPI: 1417033895
3904 SW WINDSONG DR
NPI: 1174697338
1272, Windsor Drive, Lee's Summit, Jackson County, Missouri, 64086, United States
NPI: 1235294018