Basic Information
| Provider Information | |||||||||
| NPI: | 1598827446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOPP | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6155 OAK ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641132238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163330606 | ||||||||
| FaxNumber: | 8165235418 | ||||||||
| Practice Location | |||||||||
| Address1: | 6155 OAK ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641132238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163330606 | ||||||||
| FaxNumber: | 8165235418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 00917 | MO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.