Provider Demographics
NPI:1447850870
Name:CONVERGENCE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CONVERGENCE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHNESSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-775-0702
Mailing Address - Street 1:7612 E 113TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-2946
Mailing Address - Country:US
Mailing Address - Phone:816-775-0702
Mailing Address - Fax:888-802-7986
Practice Address - Street 1:6301 ROCKHILL RD STE 107I
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1161
Practice Address - Country:US
Practice Address - Phone:816-775-0702
Practice Address - Fax:888-802-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty