Provider Demographics
NPI:1811786718
Name:CHURCH, WESLEY T JR (PHD LMSW)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:T
Last Name:CHURCH
Suffix:JR
Gender:M
Credentials:PHD LMSW
Other - Prefix:
Other - First Name:WESLEY
Other - Middle Name:T
Other - Last Name:CHURCH
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:1736 N PLANTATION DR
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-6300
Practice Address - Country:US
Practice Address - Phone:417-761-5495
Practice Address - Fax:417-761-5496
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250280621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical