Provider Demographics
NPI:1063249159
Name:A THERAPIST CLINICAL COUNSELING
Entity type:Organization
Organization Name:A THERAPIST CLINICAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-237-0006
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-0021
Mailing Address - Country:US
Mailing Address - Phone:816-237-0006
Mailing Address - Fax:
Practice Address - Street 1:600 SW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3988
Practice Address - Country:US
Practice Address - Phone:816-237-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)