Provider Demographics
NPI:1073926804
Name:SECOND WIND COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:SECOND WIND COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DACIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-767-9460
Mailing Address - Street 1:8301 STATE LINE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2025
Mailing Address - Country:US
Mailing Address - Phone:816-767-9460
Mailing Address - Fax:
Practice Address - Street 1:8301 STATE LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2025
Practice Address - Country:US
Practice Address - Phone:816-767-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002758252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency