Individual
JUSTIN PUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
200 NE MISSOURI RD STE 200, LEES SUMMIT, MO 64086-4722
(816) 200-0390
Mailing address
1901 SE 6TH TER, LEES SUMMIT, MO 64063-1009
(816) 729-1836
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6513
MO
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
2014027182
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/12/2014
Last updated
01/06/2021
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