Organization
MIND SHIELD AND SWORD THERAPY, LLC
Active
Organization
MIND SHIELD AND SWORD THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEREIK LANCE DOMERESE LCSW (OWNER/MEMBER)
(816) 223-8522
Entity
Organization
Contact information
Practice address
905 NE RICE RD STE B, LEES SUMMIT, MO 64086-6300
(816) 223-8522
Mailing address
2410 SW STATE ROUTE 150, LEES SUMMIT, MO 64082-2903
(816) 223-8522
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/08/2022
Last updated
06/15/2022
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