Provider Demographics
NPI:1730215617
Name:MINER, JEFF (LPC)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MINER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 WARD PKWY STE 405
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2020
Mailing Address - Country:US
Mailing Address - Phone:816-237-1820
Mailing Address - Fax:816-237-1343
Practice Address - Street 1:8080 WARD PKWY STE 405
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2020
Practice Address - Country:US
Practice Address - Phone:816-237-1820
Practice Address - Fax:816-237-1343
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001033802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499298107Medicaid