Healthcare Provider Details

I. General information

NPI: 1366371205
Provider Name (Legal Business Name): MOLLY BETH SHIPMAN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY BETH MCCLUSKEY LSCSW

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 PENROSE LN APT 303
LENEXA KS
66219-8182
US

IV. Provider business mailing address

8757 PENROSE LN APT 303
LENEXA KS
66219-8182
US

V. Phone/Fax

Practice location:
  • Phone: 913-620-5211
  • Fax:
Mailing address:
  • Phone: 913-620-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017027983
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2139
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: