Healthcare Provider Details

I. General information

NPI: 1750258471
Provider Name (Legal Business Name): 2ND CHANCE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TROOST AVE # 1060
KANSAS CITY MO
64108-1540
US

IV. Provider business mailing address

117 S LEXINGTON ST STE 100
HARRISONVILLE MO
64701-2444
US

V. Phone/Fax

Practice location:
  • Phone: 816-744-5657
  • Fax:
Mailing address:
  • Phone: 816-744-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ANDERSON
Title or Position: DIRECTOR
Credential:
Phone: 816-744-5657