Healthcare Provider Details

I. General information

NPI: 1083395057
Provider Name (Legal Business Name): COUNSELING & THERAPEUTIC SERVICES OF JOHNSON CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 W 87TH STREET PKWY STE 130
LENEXA KS
66215-4517
US

IV. Provider business mailing address

8818 GOLDEN LN
DE SOTO KS
66018-7501
US

V. Phone/Fax

Practice location:
  • Phone: 913-963-9990
  • Fax: 816-227-6931
Mailing address:
  • Phone: 913-963-9990
  • Fax: 816-227-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LARA WISDOM
Title or Position: OWNER
Credential: LCPC
Phone: 913-963-9990