Provider Demographics
NPI:1104559244
Name:NORTHLAND COUNSELING SERVICES
Entity type:Organization
Organization Name:NORTHLAND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX. DIR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:816-505-0909
Mailing Address - Street 1:4131 N. MULBERRY DR. SUITE 245
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2259
Mailing Address - Country:US
Mailing Address - Phone:816-505-0909
Mailing Address - Fax:816-505-0908
Practice Address - Street 1:4131 N. MULBERRY DR. SUITE 245
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-2259
Practice Address - Country:US
Practice Address - Phone:816-505-0909
Practice Address - Fax:816-505-0908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty