Provider Demographics
NPI:1114966041
Name:INSTITUTE ON BEREAVEMENT & LIFE TRANSITION, INC
Entity Type:Organization
Organization Name:INSTITUTE ON BEREAVEMENT & LIFE TRANSITION, INC
Other - Org Name:INSTITUTE ON LIFE TRANSITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFIELD-MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:816-419-3146
Mailing Address - Street 1:549 SE SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1036
Mailing Address - Country:US
Mailing Address - Phone:816-419-3146
Mailing Address - Fax:816-525-3416
Practice Address - Street 1:549 SE SHILOH DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1036
Practice Address - Country:US
Practice Address - Phone:816-419-3146
Practice Address - Fax:816-525-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000159892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty