Basic Information
| Provider Information | |||||||||
| NPI: | 1770989303 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BPH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BEHAVIORAL HEALTH PARTNERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6155 OAK ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641132240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163330606 | ||||||||
| FaxNumber: | 8165235418 | ||||||||
| Practice Location | |||||||||
| Address1: | 6155 OAK ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641132240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163330606 | ||||||||
| FaxNumber: | 8165235418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHIPPS | ||||||||
| AuthorizedOfficialFirstName: | ELISABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8163330606 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2012019369 | MO | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.