Healthcare Provider Details

I. General information

NPI: 1396609269
Provider Name (Legal Business Name): COMMUNITY BRIDGE RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 DOUGLAS AVE
KANSAS CITY KS
66106-2254
US

IV. Provider business mailing address

5112 DOUGLAS AVE
KANSAS CITY KS
66106-2254
US

V. Phone/Fax

Practice location:
  • Phone: 316-749-8340
  • Fax:
Mailing address:
  • Phone: 316-749-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SUZANNE LUBBERS
Title or Position: CEO
Credential: LMAC
Phone: 316-749-8340