Provider Demographics
NPI:1851735468
Name:COUNSELORS OBEDIENTLY PREVENTING SUBSTANCE ABUSE
Entity Type:Organization
Organization Name:COUNSELORS OBEDIENTLY PREVENTING SUBSTANCE ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, SA COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:RSAP, BS
Authorized Official - Phone:816-923-9212
Mailing Address - Street 1:3534 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2535
Mailing Address - Country:US
Mailing Address - Phone:816-923-9212
Mailing Address - Fax:816-921-0022
Practice Address - Street 1:3800 AGNES AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2539
Practice Address - Country:US
Practice Address - Phone:816-923-9212
Practice Address - Fax:816-921-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service