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General NPI Number Information
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NPI Number | 1477877223
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Entity Type | Organization
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Legal Business Name | LILAC CENTER LLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 2029 BUCHANAN ST
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City | KANSAS CITY
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State | MO
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Zip | 64116-3405
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Country | US
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Telephone | 816-221-0305
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Fax | 816-221-9121
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Provider Business Mailing Address
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Address Line | 2029 BUCHANAN ST
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City | KANSAS CITY
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State | MO
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Zip | 64116-3405
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Country | US
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Telephone | 816-221-0305
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Fax | 816-221-9121
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. AMY M TIBBITTS
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Credential | LCSW
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Telephone | 816-221-0305
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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 | 2000174524
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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