Healthcare Provider Details

I. General information

NPI: 1194046474
Provider Name (Legal Business Name): CENTERPOINTE BEHAVIORAL HEALTH KANSAS CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 NE LAKEWOOD WAY 100
LEES SUMMIT MO
64064-2060
US

IV. Provider business mailing address

763 S NEW BALLAS RD SUITE 300
SAINT LOUIS MO
63141-8704
US

V. Phone/Fax

Practice location:
  • Phone: 314-393-3954
  • Fax: 314-842-0772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. IRSHAD KHAN
Title or Position: CONSULTANT
Credential:
Phone: 314-393-3954