Provider Demographics
NPI:1447086285
Name:CULLEY, JESSIE CHRISTINE (PLPC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:CHRISTINE
Last Name:CULLEY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 RENNER BLVD APT 3001
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-3039
Mailing Address - Country:US
Mailing Address - Phone:856-381-8929
Mailing Address - Fax:
Practice Address - Street 1:400 SW LONGVIEW BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2112
Practice Address - Country:US
Practice Address - Phone:816-761-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023022565101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor