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General NPI Number Information
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NPI Number | 1174977268
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Entity Type | Organization
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Legal Business Name | TAILORED LIFE TRANSITIONS, LLC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 32 WESTWOODS DR
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City | LIBERTY
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State | MO
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Zip | 64068-3519
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Country | US
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Telephone | 816-425-1734
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Fax |
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Provider Business Mailing Address
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Address Line | 11428 N DITZLER AVE
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City | KANSAS CITY
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State | MO
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Zip | 64157-8218
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Country | US
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Telephone | 319-217-1375
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | LASHARON TAYLOR
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Credential | LMHC
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Telephone | 319-217-1375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 079016
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License Number State | IA
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