Provider Demographics
NPI:1720592330
Name:ATTACHMENT AND TRAUMA THERAPY LLC
Entity Type:Organization
Organization Name:ATTACHMENT AND TRAUMA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEBEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-607-1775
Mailing Address - Street 1:222 W GREGORY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1145
Mailing Address - Country:US
Mailing Address - Phone:816-607-1775
Mailing Address - Fax:816-379-3748
Practice Address - Street 1:222 W GREGORY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-607-1775
Practice Address - Fax:816-379-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160323631041C0700X
KS97071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty