Healthcare Provider Details

I. General information

NPI: 1881342921
Provider Name (Legal Business Name): HARAMBEE CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 E 31ST ST
KANSAS CITY MO
64128-1516
US

IV. Provider business mailing address

PO BOX 140312
KANSAS CITY MO
64114-0312
US

V. Phone/Fax

Practice location:
  • Phone: 816-365-0077
  • Fax:
Mailing address:
  • Phone: 816-365-0077
  • 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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN DIAL
Title or Position: CEO
Credential:
Phone: 816-365-0077