Adservior Mediation Services, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

ADSERVIOR MEDIATION SERVICES, LLC

Practice address

6220 Blue Ridge Cutoff
Ste. 204
Raytown, MO 64133-3700

Phone

(816) 737-1538

NPI assigned

Dec 28, 2010

Last updated

Dec 28, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Floyd Clarence Wiggins III, P.TH.D/C.M.C

Title

Doctor, Pastor

Phone

(816) 737-1538

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293494400000",
    "number": "1255635660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9471",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641330271",
            "telephone_number": "816-737-1538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6220 BLUE RIDGE CUTOFF",
            "address_2": "STE. 204",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641333700",
            "telephone_number": "816-737-1538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADSERVIOR MEDIATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2010-12-28",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "FLOYD",
        "authorized_official_middle_name": "CLARENCE",
        "authorized_official_title_or_position": "DOCTOR, PASTOR",
        "authorized_official_telephone_number": "816-737-1538",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "P.TH.D/C.M.C"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Raytown, MO
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; 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.