Organization
CLJ FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE LEE JOHNSON (EXECUTIVE DIRECTOR)
(913) 208-4406
Entity
Organization
Contact information
Practice address
2311 N 102ND ST, KANSAS CITY, KS 66109-3612
(913) 208-4406
(913) 328-1646
Mailing address
2311 N 102ND ST, KANSAS CITY, KS 66109-3612
(913) 208-4406
(913) 328-1646
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200251220A
—
KS
Enumeration date
10/07/2013
Last updated
10/07/2013
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