Healthcare Provider Details

I. General information

NPI: 1639034341
Provider Name (Legal Business Name): KANSAS CITY BEHAVIORAL HEALTH HOLDCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 COLLEGE BLVD
LEAWOOD KS
66211-1936
US

IV. Provider business mailing address

4520 MAIN ST STE 1500
KANSAS CITY MO
64111-1868
US

V. Phone/Fax

Practice location:
  • Phone: 816-877-2005
  • Fax:
Mailing address:
  • Phone: 816-877-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LEE DUCKWORTH HAM
Title or Position: BOARD OF DIRECTORS
Credential:
Phone: 816-877-2005