Healthcare Provider Details

I. General information

NPI: 1396651824
Provider Name (Legal Business Name): ROAD TO RECOVERY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SE BAYBERRY LN STE 101
LEES SUMMIT MO
64063-4385
US

IV. Provider business mailing address

1321 SE PRINCETON PL
LEES SUMMIT MO
64081-2751
US

V. Phone/Fax

Practice location:
  • Phone: 816-371-7128
  • Fax:
Mailing address:
  • Phone: 816-522-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY HALL
Title or Position: LPC
Credential:
Phone: 816-522-1820