MEDICARE: CHRISTIAN FAMILYSERVICES DBA WESTPORT COUNSELING ASSOCIATES

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	101YM0800X	Mental Health Counselor	001169	MO

General Provider Information

NPI Number	:	1871579912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN FAMILYSERVICES DBA WESTPORT COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	4149 PENNSYLVANIA AVE
Second Line	:	SUITE 205
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3034
Country	:	US
Telephone Number	:	816-531-6030
Fax Number	:	913-648-4799

Provider Business Practice Location Address
First Line	:	4149 PENNSYLVANIA AVE
Second Line	:	SUITE 205
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3034
Country	:	US
Telephone Number	:	816-531-6030
Fax Number	:	913-648-4799

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN MYERS
Credential	:
Telephone Number	:	816-531-6030

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	09/25/2007

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