Organization
DIVERSIFY U
Active
Other names
DIVERSIFY U
Organization subpart
No
Provider details
NPI number
Authorized official
FREDICK LEON JOHNSON (OWNER)
(816) 935-7307
Entity
Organization
Contact information
Practice address
6512 N OAK TRFY, GLADSTONE, MO 64118-3329
(816) 935-7307
Mailing address
6512 N OAK TRFY, GLADSTONE, MO 64118-3329
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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