Organization
EASTERN JACKSON COUNTY PSYCHIATRIC ASSOC INC
Active
Organization
EASTERN JACKSON COUNTY PSYCHIATRIC ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA J KURTZ (PRACTICE ADMINISTRATOR)
(816) 373-1911
Entity
Organization
Contact information
Practice address
17221 E 23RD ST S, #206, INDEPENDENCE, MO 64057-1803
(816) 373-1911
Mailing address
17221 E 23RD ST S, #206, INDEPENDENCE, MO 64057-1803
(816) 373-1911
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08304016
BCBSKC
MO
01
—
10712013
BCBSKC
MO
Enumeration date
04/12/2006
Last updated
09/11/2025
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