Provider Demographics
NPI:1578635124
Name:KOCH MENTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:KOCH MENTAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN MN CS
Authorized Official - Phone:816-561-5700
Mailing Address - Street 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 251 KOCH MENTAL HEALTH SERVICES INC
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112
Mailing Address - Country:US
Mailing Address - Phone:816-561-5700
Mailing Address - Fax:816-561-5700
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 251
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112
Practice Address - Country:US
Practice Address - Phone:816-561-5700
Practice Address - Fax:816-561-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM00029111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD060000Medicare ID - Type UnspecifiedGP