Healthcare Provider Details

I. General information

NPI: 1609274430
Provider Name (Legal Business Name): AUTISM, BEHAVIOR, AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHAWNEE ST
LEAVENWORTH KS
66048-1955
US

IV. Provider business mailing address

13115 W 74TH ST
SHAWNEE KS
66216-4412
US

V. Phone/Fax

Practice location:
  • Phone: 913-206-8154
  • Fax: 913-608-5756
Mailing address:
  • Phone: 913-206-8154
  • Fax: 913-608-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number932
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1031397
License Number StateKS

VIII. Authorized Official

Name: DR. LISA DYAN WALSH
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 913-206-8154