Individual
DR. DEBRA R MAMMADOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
117 S LEXINGTON ST STE 100, HARRISONVILLE, MO 64701-2444
(414) 839-4579
(855) 202-6591
Mailing address
709 N 6TH ST STE 219, KANSAS CITY, KS 66101-3031
(414) 839-4579
(855) 202-6591
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2713
KS
103TC0700X
Clinical Psychologist
Primary
02979
KS
103TC0700X
Clinical Psychologist
2018042701
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20113801B
—
KS
05
—
490057295
—
MO
Enumeration date
08/03/2016
Last updated
02/17/2026
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