Healthcare Provider Details

I. General information

NPI: 1295082360
Provider Name (Legal Business Name): CC COUNSELING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NE 72ND ST
GLADSTONE MO
64118-1826
US

IV. Provider business mailing address

5119 NW 85TH ST
KANSAS CITY MO
64154-2793
US

V. Phone/Fax

Practice location:
  • Phone: 816-872-6656
  • Fax: 816-420-8710
Mailing address:
  • Phone: 816-872-6656
  • Fax: 816-420-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2012010037
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CURTIS WAYNE CAMPBELL
Title or Position: SOLE OWNER
Credential: LCSW, LSCSW, LCAC
Phone: 816-872-6656