Organization
LILAC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY M TIBBITTS LCSW (DIRECTOR)
(816) 221-0305
Entity
Organization
Contact information
Practice address
2029 BUCHANAN ST, KANSAS CITY, MO 64116-3405
(816) 221-0305
(816) 221-9121
Mailing address
2029 BUCHANAN ST, KANSAS CITY, MO 64116-3405
(816) 221-0305
(816) 221-9121
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2000174524
MO
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201354450A
—
KS
05
—
830117171
—
MO
Enumeration date
03/23/2010
Last updated
05/23/2025
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