MEDICARE: SARITA LYNNE MINISTRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YP1600X	Pastoral Counselor
4	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1093159568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARITA LYNNE MINISTRIES

Provider Business Mailing Address
First Line	:	2214 BENTON BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-4157
Country	:	US
Telephone Number	:	816-561-0035
Fax Number	:	816-569-2343

Provider Business Practice Location Address
First Line	:	2214 BENTON BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-4157
Country	:	US
Telephone Number	:	816-561-0035
Fax Number	:	816-569-2343

Authorized Official
Title or Position	:	CEO/EXECUTIVE DIRECTOR
Name	:	DR. SARITA LYNN GRAHAM
Credential	:	PHD,RASAC, MRSS/MRSS
Telephone Number	:	816-561-0035

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	12/16/2014

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