=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558213942
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADICAL EMPOWERMENT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2026
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 W 34TH ST STE 406
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-972-1597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 W 34TH ST STE 406
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-972-1597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR/LEAD THERAPIST
-----------------------------------------------------
Name | MR. CECIL WATTREE
-----------------------------------------------------
Credential | LCSW, LSCSW
-----------------------------------------------------
Telephone | 816-972-1597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------