MEDICARE: PLAZA ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376868059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA ACADEMY

Provider Business Mailing Address
First Line	:	601 WESTPORT RD
Second Line	:	P.O. BOX 10361
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3127
Country	:	US
Telephone Number	:	816-561-0770
Fax Number	:	816-561-2530

Provider Business Practice Location Address
First Line	:	601 WESTPORT RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3127
Country	:	US
Telephone Number	:	816-561-0770
Fax Number	:	816-561-2530

Authorized Official
Title or Position	:	FOUNDER/EXECUTIVE DIRECTOR
Name	:	DR. GARY OGLE SEABAUGH
Credential	:	PH.D.
Telephone Number	:	816-561-0770

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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Directions to “PLAZA ACADEMY ” Practice Location

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