=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659051373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AM BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2023
-----------------------------------------------------
Last Update Date | 07/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 E 101ST TER STE 350
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64131-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-783-7982
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 N WALNUT LN
-----------------------------------------------------
City | LONE JACK
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64070-9321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-783-7982
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMANDA MARTINEZ
-----------------------------------------------------
Credential | LPC-MO, LCPC-KS
-----------------------------------------------------
Telephone | 816-783-7982
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------