Healthcare Provider Details

I. General information

NPI: 1508369281
Provider Name (Legal Business Name): PATTERNS BEHAVIORAL SERVICES MISSOURI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 NICHOLS RD STE 200
KANSAS CITY MO
64112-2036
US

IV. Provider business mailing address

3230 E IMPERIAL HWY
BREA CA
92821-6721
US

V. Phone/Fax

Practice location:
  • Phone: 657-444-9002
  • Fax:
Mailing address:
  • Phone: 657-444-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IHAB SHAHAWI
Title or Position: CEO
Credential:
Phone: 760-631-7550