Healthcare Provider Details

I. General information

NPI: 1326337536
Provider Name (Legal Business Name): AFSOUN LEE MORADI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 MARSHALL DR
LENEXA KS
66214-1562
US

IV. Provider business mailing address

21350 W 153RD ST
OLATHE KS
66061-5413
US

V. Phone/Fax

Practice location:
  • Phone: 913-499-8100
  • Fax: 913-499-8111
Mailing address:
  • Phone: 913-322-4900
  • Fax: 913-621-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2336
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: