Organization
HEARTLAND CENTER FOR BEHAVIORAL CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRNA TRICKEY (CEO)
(816) 421-6670
Entity
Organization
Contact information
Practice address
1730 PROSPECT AVE, KANSAS CITY, MO 64127-2544
(816) 421-6670
Mailing address
1730 PROSPECT AVE, KANSAS CITY, MO 64127-2544
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053587469
—
MO
05
—
867762106
—
MO
Enumeration date
04/15/2016
Last updated
04/15/2016
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