Healthcare Provider Details

I. General information

NPI: 1477877223
Provider Name (Legal Business Name): LILAC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 BUCHANAN ST
KANSAS CITY MO
64116-3405
US

IV. Provider business mailing address

2029 BUCHANAN ST
KANSAS CITY MO
64116-3405
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-0305
  • Fax: 816-221-9121
Mailing address:
  • Phone: 816-221-0305
  • Fax: 816-221-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2000174524
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY M TIBBITTS
Title or Position: DIRECTOR
Credential: LCSW
Phone: 816-221-0305