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NPI Code Detail

MEDICARE: KANSAS CITY COGNITIVE-BEHAVIORAL THERAPY, LLC

MEDICARE: KANSAS CITY COGNITIVE-BEHAVIORAL THERAPY, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2010006423MO

General Provider Information

NPI Number : 1235450768
Entity Type Code : Organization
Provider Name (Legal Business Name) : KANSAS CITY COGNITIVE-BEHAVIORAL THERAPY, LLC
Provider Business Mailing Address
First Line : 6112 NW 77TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-1585
Country : US
Telephone Number : 816-401-6960
Fax Number :
Provider Business Practice Location Address
First Line : 6112 NW 77TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-1585
Country : US
Telephone Number : 816-401-6960
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. CHRIS SORRENTINO
Credential : LPC, NCC
Telephone Number : 816-401-6960
Provider Enumeration Date : 06/18/2010
Last Update Date : 06/18/2010

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Directions to “KANSAS CITY COGNITIVE-BEHAVIORAL THERAPY, LLC ” Practice Location

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