Healthcare Provider Details

I. General information

NPI: 1518360031
Provider Name (Legal Business Name): ISIAH LYKES LMLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E KING ST
ANDOVER KS
67002-8964
US

IV. Provider business mailing address

2551 SAINT ANDREW CT
GODDARD KS
67052-8556
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-5047
  • Fax: 316-733-5060
Mailing address:
  • Phone: 620-218-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: