Healthcare Provider Details

I. General information

NPI: 1144671785
Provider Name (Legal Business Name): ANDY CARAWAY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DEREK CARAWAY

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8629 BLUEJACKET ST SUITE 100
LENEXA KS
66214-1604
US

IV. Provider business mailing address

8629 BLUEJACKET ST SUITE 100
LENEXA KS
66214-1604
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-3553
  • Fax: 913-677-3282
Mailing address:
  • Phone: 913-677-3553
  • Fax: 913-677-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2918
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: