Healthcare Provider Details

I. General information

NPI: 1215166731
Provider Name (Legal Business Name): BRYAN E VIGNERY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 STRANG LINE RD
LENEXA KS
66215
US

IV. Provider business mailing address

16950 S PENROSE LN
OLATHE KS
66062-8125
US

V. Phone/Fax

Practice location:
  • Phone: 913-568-8276
  • Fax: 913-696-1403
Mailing address:
  • Phone: 913-568-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number787
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007016865
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number787
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: