Provider Demographics
NPI:1356778260
Name:JOHN AND JEANNEEN ENT
Entity type:Organization
Organization Name:JOHN AND JEANNEEN ENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNEEN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-415-2333
Mailing Address - Street 1:9601 NE BARRY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-7633
Mailing Address - Country:US
Mailing Address - Phone:816-415-2333
Mailing Address - Fax:816-781-1111
Practice Address - Street 1:9601 NE BARRY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-7633
Practice Address - Country:US
Practice Address - Phone:816-415-2333
Practice Address - Fax:816-781-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002009408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495765109Medicaid