Provider Demographics
NPI:1487499083
Name:MY MENTAL HEALTH IS KICKING IN LLC
Entity type:Organization
Organization Name:MY MENTAL HEALTH IS KICKING IN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHATAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-335-5159
Mailing Address - Street 1:12300 E US HIGHWAY 40 STE A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6008
Mailing Address - Country:US
Mailing Address - Phone:725-335-5159
Mailing Address - Fax:
Practice Address - Street 1:12300 E US HIGHWAY 40 STE A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6008
Practice Address - Country:US
Practice Address - Phone:725-335-5159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health