Shane Matthew Witzki | Liberty, MO • PECOS Search

Shane Matthew Witzki

Counselor

Behavioral Health & Social Service Providers

110 Westwoods Dr, Liberty, MO 64068-1181

(816) 368-1889 (816) 547-2968

PECOS Enrollment

Based on the most recent information from CMS, provider Shane Matthew Witzki does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1053039461
Provider Type
Individual
Full Name
Witzki, Shane Matthew
Gender
Male

Sole Proprietor
Yes
Enumeration Date
8/22/2022
Last Updated
8/22/2022

Contact Information

Practice Location

110 Westwoods Dr, Liberty, MO 64068-1181

Unlisted Fax

Mailing Location

1809 Shannon Dr, Liberty, MO 64068-2892

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YP2500X Primary	Description Counselor Behavioral Health & Social Service Providers	License 2020024396 Missouri