MEDICARE: NEW SEASON COUNSELING 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
1	101YP2500X	Professional Counselor	2013008441	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437694841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SEASON COUNSELING LLC

Provider Business Mailing Address
First Line	:	7712 NW 69TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64152-2937
Country	:	US
Telephone Number	:	816-665-6445
Fax Number	:

Provider Business Practice Location Address
First Line	:	8341 NW MACE RD STE 120
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64152-4618
Country	:	US
Telephone Number	:	816-368-1371
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STACEY CHESTNUT-WATSON
Credential	:	LPC
Telephone Number	:	816-665-6445

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	02/15/2018

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Directions to “NEW SEASON COUNSELING LLC ” Practice Location

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