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General NPI Number Information
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NPI Number | 1629485974
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Entity Type | Organization
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Legal Business Name | ADDICTION STRESS CENTER
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 1225 N 78TH ST SUITE J
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City | KANSAS CITY
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State | KS
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Zip | 66112-2401
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Country | US
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Telephone | 913-299-9255
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Fax | 913-299-0414
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Provider Business Mailing Address
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Address Line | 1225 N 78TH ST SUITE J
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City | KANSAS CITY
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State | KS
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Zip | 66112-2401
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Country | US
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Telephone | 913-299-9255
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Fax | 913-299-0414
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM MILLER
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Credential |
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Telephone | 913-907-7911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 623
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License Number State | KS
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