Provider Demographics
NPI:1245358001
Name:JACOBS WELL OF KANSAS CITY MINISTRIES
Entity type:Organization
Organization Name:JACOBS WELL OF KANSAS CITY MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,NCC
Authorized Official - Phone:816-923-2557
Mailing Address - Street 1:5910 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64129-1153
Mailing Address - Country:US
Mailing Address - Phone:816-923-2557
Mailing Address - Fax:816-214-8853
Practice Address - Street 1:5910 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-1153
Practice Address - Country:US
Practice Address - Phone:816-923-2557
Practice Address - Fax:816-214-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005041497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490104007Medicaid