Active NPI
Mark A Kassebaum, LPC
- Counselor
- Linn Creek, MO
National Provider Identifier
1447509948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2007004366
- Practice address
- 1091 Midway Dr
Linn Creek, MO 65052-1687 - Phone
- (573) 346-6758
- Fax
- (573) 346-0621
- NPI assigned
- Aug 30, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2007004366 | MO | Primary |
Addresses
Primary practice location
1091 Midway Dr
Linn Creek, MO 65052-1687
Mailing address
1091 Midway Dr
Linn Creek, MO 65052-1687
Phone (573) 346-6758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007004366 | MO | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346284800000",
"number": "1447509948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1091 MIDWAY DR",
"city": "LINN CREEK",
"state": "MO",
"postal_code": "650521687",
"telephone_number": "573-346-6758",
"fax_number": "573-346-0621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1091 MIDWAY DR",
"city": "LINN CREEK",
"state": "MO",
"postal_code": "650521687",
"telephone_number": "573-346-6758",
"fax_number": "573-346-0621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASSEBAUM",
"first_name": "MARK",
"middle_name": "A",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-30",
"last_updated": "2012-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MO",
"license": "2007004366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Linn Creek, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.