Provider Demographics
NPI:1871794743
Name:MCCORKLE, RONALD R (MA, LPC, DAPA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:MCCORKLE
Suffix:
Gender:M
Credentials:MA, LPC, DAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 N HIGHLAND AVE
Mailing Address - Street 2:# 1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2091
Mailing Address - Country:US
Mailing Address - Phone:816-454-5291
Mailing Address - Fax:
Practice Address - Street 1:707 W 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1803
Practice Address - Country:US
Practice Address - Phone:816-561-4466
Practice Address - Fax:816-753-2221
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional