MEDICARE: JUSTIN KAUGHMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC04571	KS
2	101YP2500X	Professional Counselor	LPC04571	KS

General Provider Information

NPI Number	:	1528839156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN KAUGHMAN LPC

Provider Business Mailing Address
First Line	:	11715 S SHANNAN ST APT 1305
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-3759
Country	:	US
Telephone Number	:	573-701-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 IOWA ST STE 4
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66044-1869
Country	:	US
Telephone Number	:	573-701-9405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	02/19/2025

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Directions to “ JUSTIN KAUGHMAN LPC” Practice Location

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