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General NPI Number Information
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NPI Number | 1235450768
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Entity Type | Organization
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Legal Business Name | KANSAS CITY COGNITIVE-BEHAVIORAL THERAPY, LLC
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 6112 NW 77TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64151-1585
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Country | US
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Telephone | 816-401-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 6112 NW 77TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64151-1585
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Country | US
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Telephone | 816-401-6960
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHRIS SORRENTINO
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Credential | LPC, NCC
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Telephone | 816-401-6960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2010006423
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License Number State | MO
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