Provider Demographics
NPI:1346485257
Name:WESTERN MISSOURI MENTAL HEALTH
Entity Type:Organization
Organization Name:WESTERN MISSOURI MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY ROOM SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:OWENS-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-512-7213
Mailing Address - Street 1:4939 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2544
Mailing Address - Country:US
Mailing Address - Phone:816-861-3278
Mailing Address - Fax:
Practice Address - Street 1:1000 E. 24TH STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-512-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO020931705Medicaid