Healthcare Provider Details

I. General information

NPI: 1982923389
Provider Name (Legal Business Name): MILESTONE BEHAVIORAL HEALTHCARE SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 224 HIGHWAY
WELLINGTON MO
64097
US

IV. Provider business mailing address

PO BOX 423
WELLINGTON MO
64097-0423
US

V. Phone/Fax

Practice location:
  • Phone: 816-934-0110
  • Fax: 866-224-2185
Mailing address:
  • Phone: 816-934-0110
  • Fax: 866-224-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010012556
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007015277
License Number StateMO

VIII. Authorized Official

Name: LINDA L KURIAN
Title or Position: PRESIDENT
Credential: MS, LPC
Phone: 816-934-0110