Debra R Mammadova, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

02979 Issued in KS

Practice address

117 S Lexington St Ste 100
Harrisonville, MO 64701-2444

Phone

(414) 839-4579

Fax

(855) 202-6591

NPI assigned

Aug 3, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. Debra R Lewis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1073066320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 N 6TH ST STE 219",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661013031",
            "telephone_number": "414-839-4579",
            "fax_number": "855-202-6591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S LEXINGTON ST STE 100",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "647012444",
            "telephone_number": "414-839-4579",
            "fax_number": "855-202-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMMADOVA",
        "first_name": "DEBRA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "02979",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2018042701",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20113801B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490057295",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "LEWIS",
            "middle_name": "R",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ebony Nicole Love
• Melissa Marie Lowry, FNP
• Donald Macleod, DPT, PT, MBA
• Scott A Maid, PSY.D., PLPC
• Kelsi Renee Mainard, SLPA
• Francis X. Matthews, D.D.S.
• Mariah Grace May, P.T.
• Erin Elizabeth McCarthy, MS/OTR/L
• Vicki McGhghy, COTA
• Alisa McNeill

• Clinical Psychologist in Harrisonville, MO
• Providers in Harrisonville, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.