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General NPI Number Information
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NPI Number | 1801571765
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Entity Type | Organization
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Legal Business Name | MODERN ARC WELLNESS LLC
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 5709 NW 64TH TER
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City | KANSAS CITY
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State | MO
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Zip | 64151-2382
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Country | US
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Telephone | 816-216-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 5709 NW 64TH TER
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City | KANSAS CITY
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State | MO
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Zip | 64151-2382
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Country | US
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Telephone | 816-383-3466
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | MS. DANYELL BROWN
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Credential | LPC, LCPC, NCC
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Telephone | 816-383-3466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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