Provider Demographics
NPI:1467814376
Name:KANSAS CITY THERAPY, LLC
Entity Type:Organization
Organization Name:KANSAS CITY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPY/MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:BORCHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-405-9985
Mailing Address - Street 1:4635 WYANDOTTE ST
Mailing Address - Street 2:SUTIE 204
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1509
Mailing Address - Country:US
Mailing Address - Phone:816-599-3918
Mailing Address - Fax:
Practice Address - Street 1:4635 WYANDOTTE ST
Practice Address - Street 2:SUTIE 204
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1509
Practice Address - Country:US
Practice Address - Phone:816-599-3918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130031181041C0700X
MO20110107461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO980336OtherMISSOURI CARE
MO1225304264Medicaid
MOPTAN #H74000010OtherMEDICARE
MO1649587148Medicaid