Provider Demographics
NPI:1376763516
Name:CATHOLIC CHARITIES OF KANSAS CITY-ST. JOSEPH, INC.
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF KANSAS CITY-ST. JOSEPH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-232-2885
Mailing Address - Street 1:2816 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-3339
Mailing Address - Country:US
Mailing Address - Phone:816-233-1324
Mailing Address - Fax:
Practice Address - Street 1:902 EDMOND ST STE 204
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2762
Practice Address - Country:US
Practice Address - Phone:816-232-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO43071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty