Healthcare Provider Details

I. General information

NPI: 1386507523
Provider Name (Legal Business Name): GREAT OAKS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 WESTPORT RD
KANSAS CITY MO
64111-4307
US

IV. Provider business mailing address

1942 STEWART AVE APT G20
LAWRENCE KS
66046-2513
US

V. Phone/Fax

Practice location:
  • Phone: 913-349-1458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL CLARK
Title or Position: CEO
Credential:
Phone: 913-349-1458