Provider Demographics
NPI:1396229357
Name:RESILIENT HOPE KC LLC
Entity type:Organization
Organization Name:RESILIENT HOPE KC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.P.C.
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:DOUBENMIER
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:816-520-8189
Mailing Address - Street 1:3371 SW SENSATION DR APT 1035
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-7811
Mailing Address - Country:US
Mailing Address - Phone:816-520-8189
Mailing Address - Fax:
Practice Address - Street 1:705 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-1744
Practice Address - Country:US
Practice Address - Phone:816-520-8189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619953155OtherNPI
MO497196303Medicaid