MEDICARE: HARAMBEE CIRCLE

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1881342921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARAMBEE CIRCLE

Provider Business Mailing Address
First Line	:	PO BOX 140312
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-0312
Country	:	US
Telephone Number	:	816-365-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 E 31ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1516
Country	:	US
Telephone Number	:	816-365-0077
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRYAN DIAL
Credential	:
Telephone Number	:	816-365-0077

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	03/17/2022

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Directions to “HARAMBEE CIRCLE ” Practice Location

Language	Start Address	Practice Location

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