Healthcare Provider Details

I. General information

NPI: 1174048839
Provider Name (Legal Business Name): MICHAEL MCRILL LSCSW, LMAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W 31ST ST STE G
LAWRENCE KS
66047-3051
US

IV. Provider business mailing address

1701 W 4TH ST APT D8
LAWRENCE KS
66044-4630
US

V. Phone/Fax

Practice location:
  • Phone: 785-856-0322
  • Fax: 785-856-0330
Mailing address:
  • Phone: 310-579-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07201
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number266
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: