# FREDERICK J TIRRELL PHD PROFESSIONAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Professional Association
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013076215
- **Authorized official:** WILLIAM ALBERT MOFFITT PHD (VICE PRESIDENT OWNER)
- **Authorized official phone:** (913) 651-8415

## Contact information

- **Practice address:** 3515 S 4TH STREET, LEAVENWORTH, KS 66048
- **Practice address phone:** (913) 651-8415
- **Practice address fax:** (913) 772-8580
- **Mailing address:** 3515 S 4TH STREET, LEAVENWORTH, KS 66048
- **Mailing address phone:** (913) 651-8415
- **Mailing address fax:** (913) 772-8580

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | Yes |
| 103T00000X | Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 004517 | BCBS KANSAS | KS |
| 01 | — | 08422011 | BCBS KANSAS CITY | KS |