Healthcare Provider Details

I. General information

NPI: 1144162785
Provider Name (Legal Business Name): TANEKA MONTRETTA COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 N LOCUST ST
GLADSTONE MO
64118-2531
US

IV. Provider business mailing address

8517 N HIGHLAND AVE
KANSAS CITY MO
64155-2820
US

V. Phone/Fax

Practice location:
  • Phone: 913-725-8983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026003629
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: