Healthcare Provider Details

I. General information

NPI: 1548043425
Provider Name (Legal Business Name): CRYSTAL DAWN BARFOOT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL DAWN VASSEF

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14820 W 91ST TER
LENEXA KS
66215-3013
US

IV. Provider business mailing address

14820 W 91ST TER
LENEXA KS
66215-3013
US

V. Phone/Fax

Practice location:
  • Phone: 512-673-3879
  • Fax:
Mailing address:
  • Phone: 512-673-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number67840
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.70103567
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07419
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: