Individual
BRUCE S LIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3901 RAINBOW BLVD, MS 4017, KANSAS CITY, KS 66160-0001
(913) 588-1944
(913) 588-2496
Mailing address
PO BOX 411851, KANSAS CITY, MO 64141-1851
(913) 588-1944
(913) 588-2496
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0616
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110150074
RAILROAD MEDICARE
—
01
—
11784036
BCBS KANSAS CITY
—
05
—
4957111501
—
KS
05
—
498634500
—
MO
Enumeration date
10/02/2006
Last updated
07/16/2014
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