Healthcare Provider Details

I. General information

NPI: 1659243608
Provider Name (Legal Business Name): BIRCHWOOD MIND BODY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W 63RD ST UNIT 7034
KANSAS CITY MO
64113-3201
US

IV. Provider business mailing address

301 E 69TH TER
KANSAS CITY MO
64113-2549
US

V. Phone/Fax

Practice location:
  • Phone: 816-853-8474
  • Fax: 816-207-0890
Mailing address:
  • Phone: 816-853-8474
  • Fax: 816-207-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON D GILBERT
Title or Position: OWNER
Credential: PA-C
Phone: 816-853-8474