Healthcare Provider Details

I. General information

NPI: 1467542225
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 N 5TH ST
LEAVENWORTH KS
66048-1404
US

IV. Provider business mailing address

9740 W 87TH ST
OVERLAND PARK KS
66212-4563
US

V. Phone/Fax

Practice location:
  • Phone: 913-651-5261
  • Fax: 913-651-9350
Mailing address:
  • Phone: 913-621-5090
  • Fax: 913-342-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAN M LEWIS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 913-433-2102