Provider Demographics
NPI:1750548442
Name:GENESIS SCHOOL, INC
Entity type:Organization
Organization Name:GENESIS SCHOOL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-245-5128
Mailing Address - Street 1:3800 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2168
Mailing Address - Country:US
Mailing Address - Phone:816-921-0775
Mailing Address - Fax:
Practice Address - Street 1:3800 E 44TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2168
Practice Address - Country:US
Practice Address - Phone:816-921-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health