Healthcare Provider Details

I. General information

NPI: 1932027174
Provider Name (Legal Business Name): HEADYWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N LAKE CITY VALLEY RD
BUCKNER MO
64016-9127
US

IV. Provider business mailing address

1715 N LAKE CITY VALLEY RD
BUCKNER MO
64016-9127
US

V. Phone/Fax

Practice location:
  • Phone: 816-804-4828
  • Fax: 816-804-4828
Mailing address:
  • Phone: 816-804-4828
  • Fax: 816-804-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CURTIS KOLLE
Title or Position: COUNSELING
Credential: MS, LPC
Phone: 816-804-4828