# STREET MEDICINE KC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568066587
- **Authorized official:** EDGAR BENNETT JR. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (913) 653-2897

## Contact information

- **Practice address:** 1444 E 8TH ST, KANSAS CITY, MO 64106-1712
- **Practice address phone:** (816) 434-0581
- **Mailing address:** 934 WYANDOTTE ST APT 406, KANSAS CITY, MO 64105-1644
- **Mailing address phone:** (913) 653-2897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 11/30/2020
- **Last updated:** 11/30/2020