Organization
PLAZA THERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI LYNN WIETHAN LCSW LSCSW (OWNER/PSYCHOTHERAPIST)
(917) 664-6530
Entity
Organization
Contact information
Practice address
4635 WYANDOTTE ST, SUITE 205, KANSAS CITY, MO 64112-1509
(917) 664-6530
Mailing address
4635 WYANDOTTE ST, SUITE 205, KANSAS CITY, MO 64112-1509
(917) 664-6530
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2008033440
MO
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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