MEDICARE: KC BEHAVIORAL HEALTH 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1851247084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	7216 PENNSYLVANIA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1319
Country	:	US
Telephone Number	:	913-669-1136
Fax Number	:

Provider Business Practice Location Address
First Line	:	7216 PENNSYLVANIA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1319
Country	:	US
Telephone Number	:	913-669-1136
Fax Number	:

Authorized Official
Title or Position	:	BCBA/OWNER
Name	:	TATE KNUDSEN
Credential	:
Telephone Number	:	913-669-1136

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “KC BEHAVIORAL HEALTH LLC ” Practice Location

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