Healthcare Provider Details

I. General information

NPI: 1437468345
Provider Name (Legal Business Name): TERESA REICHART-VERNON, LSCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 KAW DR STE. B
EDWARDSVILLE KS
66111-1130
US

IV. Provider business mailing address

10601 KAW DR STE. B
EDWARDSVILLE KS
66111-1130
US

V. Phone/Fax

Practice location:
  • Phone: 913-207-7674
  • Fax: 913-745-8040
Mailing address:
  • Phone: 913-207-7674
  • Fax: 913-745-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLSCSW 1463
License Number StateKS

VIII. Authorized Official

Name: TERESA REICHART-VERNON
Title or Position: OWNER
Credential: LSCSW
Phone: 913-207-7674