Healthcare Provider Details

I. General information

NPI: 1851460711
Provider Name (Legal Business Name): JAY PETERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 STATE LINE RD STE 216
KANSAS CITY MO
64114-2019
US

IV. Provider business mailing address

8301 STATE LINE RD STE 216
KANSAS CITY MO
64114-2019
US

V. Phone/Fax

Practice location:
  • Phone: 816-523-4440
  • Fax: 816-523-8782
Mailing address:
  • Phone: 816-523-4440
  • Fax: 816-523-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0065
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number020
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number300113
License Number StateMO

VIII. Authorized Official

Name: MR. LOUIS JOSEPH PETERS JR.
Title or Position: PRESIDENT
Credential: MS DMIN
Phone: 816-523-4440