Provider Demographics
NPI:1134703499
Name:YOUTH MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:YOUTH MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC, LPCC, RPT
Authorized Official - Phone:816-427-1148
Mailing Address - Street 1:512 NW PANTHER DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3388
Mailing Address - Country:US
Mailing Address - Phone:816-427-1148
Mailing Address - Fax:
Practice Address - Street 1:1201 NW JEFFERSON ST STE D
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6400
Practice Address - Country:US
Practice Address - Phone:816-427-1148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490043878Medicaid