Individual
NICHOLAS VAN WALLEGHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1911 E 23RD ST, KANSAS CITY, MO 64127-3701
(913) 706-1347
Mailing address
1911 E 23RD ST, KANSAS CITY, MO 64127-3701
(816) 241-3448
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2019026772
MO
1041C0700X
Clinical Social Worker
Primary
2022001668
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490096849
—
MO
Enumeration date
04/12/2021
Last updated
08/08/2022
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