Healthcare Provider Details

I. General information

NPI: 1376870865
Provider Name (Legal Business Name): SUMMIT BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 NW VIVION RD
KANSAS CITY MO
64118
US

IV. Provider business mailing address

1460 NW VIVION RD
KANSAS CITY MO
64118-4555
US

V. Phone/Fax

Practice location:
  • Phone: 816-853-0946
  • Fax: 816-396-8809
Mailing address:
  • Phone: 816-853-0946
  • Fax: 816-396-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA A KRATOFIL
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 816-853-0946