Healthcare Provider Details

I. General information

NPI: 1982120697
Provider Name (Legal Business Name): LINDSAY KAY PETERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 BROADWAY AVE
GREAT BEND KS
67530-3123
US

IV. Provider business mailing address

5815 BROADWAY AVE
GREAT BEND KS
67530-3123
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-2544
  • Fax:
Mailing address:
  • Phone: 620-792-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3128
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: