Organization
STREET MEDICINE KC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR BENNETT JR. (EXECUTIVE DIRECTOR)
(913) 653-2897
Entity
Organization
Contact information
Practice address
1444 E 8TH ST, KANSAS CITY, MO 64106-1712
(816) 434-0581
Mailing address
934 WYANDOTTE ST APT 406, KANSAS CITY, MO 64105-1644
(913) 653-2897
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
3336C0003X
Community/Retail Pharmacy
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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