Provider Demographics
NPI:1023411055
Name:A LIFES JOURNEY, LLC
Entity type:Organization
Organization Name:A LIFES JOURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:KORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-726-9735
Mailing Address - Street 1:PO BOX 301137
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-5137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1734 E 63RD ST
Practice Address - Street 2:SUITE 504
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3543
Practice Address - Country:US
Practice Address - Phone:816-265-1559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024577101YP2500X
MO20140242001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty