Healthcare Provider Details

I. General information

NPI: 1205938669
Provider Name (Legal Business Name): WESLEY B CRENSHAW PHD ABPP CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WES B CRENSHAW PHD ABPP

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC SUITE 104
LAWRENCE KS
66049
US

IV. Provider business mailing address

3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC SUITE 104
LAWRENCE KS
66049
US

V. Phone/Fax

Practice location:
  • Phone: 785-371-1414
  • Fax: 785-371-4519
Mailing address:
  • Phone: 785-371-1414
  • Fax: 785-371-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0894
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: