Healthcare Provider Details

I. General information

NPI: 1235450768
Provider Name (Legal Business Name): KANSAS CITY COGNITIVE-BEHAVIORAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 NW 77TH ST
KANSAS CITY MO
64151-1585
US

IV. Provider business mailing address

6112 NW 77TH ST
KANSAS CITY MO
64151-1585
US

V. Phone/Fax

Practice location:
  • Phone: 816-401-6960
  • Fax:
Mailing address:
  • Phone: 816-401-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010006423
License Number StateMO

VIII. Authorized Official

Name: MR. CHRIS SORRENTINO
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC, NCC
Phone: 816-401-6960