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General NPI Number Information
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NPI Number | 1689902991
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Entity Type | Organization
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Legal Business Name | CHILD & ADOLESCENT TRAUMA SERVICES LLP
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 630 MINNESOTA AVE SUITE 210
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City | KANSAS CITY
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State | KS
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Zip | 66101-2806
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Country | US
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Telephone | 913-735-4393
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Fax | 913-735-0188
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Provider Business Mailing Address
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Address Line | 630 MINNESOTA AVE SUITE 210
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City | KANSAS CITY
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State | KS
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Zip | 66101-2806
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Country | US
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Telephone | 913-735-4393
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Fax | 913-735-0188
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | IAN A NEWLIN
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Credential | LMFT
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Telephone | 913-735-4393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 839
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License Number State | KS
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