Provider Demographics
NPI:1255724654
Name:MBSS COUNSELING GROUP LLC
Entity type:Organization
Organization Name:MBSS COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSEDA
Authorized Official - Suffix:
Authorized Official - Credentials:CRADC
Authorized Official - Phone:816-679-2160
Mailing Address - Street 1:5510 NE ANTIOCH RD
Mailing Address - Street 2:265
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2301
Mailing Address - Country:US
Mailing Address - Phone:816-866-1192
Mailing Address - Fax:
Practice Address - Street 1:5706 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-2826
Practice Address - Country:US
Practice Address - Phone:816-866-1192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONO.67483245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children