Healthcare Provider Details

I. General information

NPI: 1538281738
Provider Name (Legal Business Name): NORTHWEST HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 FARAON ST
SAINT JOSEPH MO
64506-3044
US

IV. Provider business mailing address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-6444
  • Fax: 816-364-6929
Mailing address:
  • Phone: 816-232-6168
  • Fax: 816-232-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MATT YOUNGER
Title or Position: CEO
Credential:
Phone: 816-232-6818