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Organization
FREDERICK J TIRRELL PHD PROFESSIONAL ASSOCIATION
Active
Organization
FREDERICK J TIRRELL PHD PROFESSIONAL ASSOCIATION
Active
Other names
Professional Association
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ALBERT MOFFITT PHD (VICE PRESIDENT OWNER)
(913) 651-8415
Entity
Organization
Contact information
Practice address
3515 S 4TH STREET, LEAVENWORTH, KS 66048
(913) 651-8415
(913) 772-8580
Mailing address
3515 S 4TH STREET, LEAVENWORTH, KS 66048
(913) 651-8415
(913) 772-8580
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
NULL
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004517
BCBS KANSAS
KS
01
—
08422011
BCBS KANSAS CITY
KS
Enumeration date
12/06/2006
Last updated
08/22/2020
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