MEDICARE: CHARLES B STAATS LMFT

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	106H00000X	Marriage & Family Therapist	2449	KS

General Provider Information

NPI Number	:	1780013763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES B STAATS LMFT

Provider Business Mailing Address
First Line	:	1359 CRESCENT DR
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-4362
Country	:	US
Telephone Number	:	316-621-0821
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 N MAIN ST
Second Line	:	2ND FLOOR FRONT
City	:	EL DORADO
State	:	KS
Zip	:	67042-2017
Country	:	US
Telephone Number	:	316-251-2354
Fax Number	:

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

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	03/21/2024

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Directions to “ CHARLES B STAATS LMFT” Practice Location

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