Healthcare Provider Details

I. General information

NPI: 1467753764
Provider Name (Legal Business Name): HEALING PATHWAY VICTIM SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 NE TUDOR RD APT 7
LEES SUMMIT MO
64086-5785
US

IV. Provider business mailing address

PO BOX 7185
KANSAS CITY MO
64113-0185
US

V. Phone/Fax

Practice location:
  • Phone: 816-377-9516
  • Fax:
Mailing address:
  • Phone: 816-377-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA L ROBERTS
Title or Position: PRESIDENT
Credential: M.A.
Phone: 816-377-9516