MEDICARE: NORTHLAND FAMILY COUNSELING CENTER, INC.

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1891872420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND FAMILY COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	429 N.E. 69 HIGHWAY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3118
Country	:	US
Telephone Number	:	816-452-8777
Fax Number	:	816-452-8795

Provider Business Practice Location Address
First Line	:	429 N.E. 69 HIGHWAY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3118
Country	:	US
Telephone Number	:	816-452-8777
Fax Number	:	816-452-8795

Authorized Official
Title or Position	:	EXCUTIVE DIRECTOR
Name	:	MR. MAURICE L CUMMINGS
Credential	:	M.A., MSW
Telephone Number	:	816-454-8777

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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