MEDICARE: TRAUMA AND BALANCE COUNSELING SERVICES, 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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05617	OTHER	KS	LSCSW

General Provider Information

NPI Number	:	1477263523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA AND BALANCE COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	11509 CAMPBELL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-3830
Country	:	US
Telephone Number	:	816-721-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	11509 CAMPBELL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-3830
Country	:	US
Telephone Number	:	816-721-8166
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/SOLE OWNER
Name	:	PAOLA MARIA CAPRA
Credential	:	LSCSW/LCSW
Telephone Number	:	816-721-8166

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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