MEDICARE: 2ND CHANCE BEHAVIORAL HEALTH LLC

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	2084P0800X	Psychiatry Physician
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750258471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND CHANCE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	117 S LEXINGTON ST STE 100
Second Line	:
City	:	HARRISONVILLE
State	:	MO
Zip	:	64701-2444
Country	:	US
Telephone Number	:	816-744-5657
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 TROOST AVE # 1060
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1540
Country	:	US
Telephone Number	:	816-744-5657
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHARLES ANDERSON
Credential	:
Telephone Number	:	816-744-5657

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	11/07/2025

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