Healthcare Provider Details

I. General information

NPI: 1396371977
Provider Name (Legal Business Name): ANDREA MICHELLE LEBEAU LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 158TH RD
MAYETTA KS
66509-8866
US

IV. Provider business mailing address

11400 158TH RD
MAYETTA KS
66509-8866
US

V. Phone/Fax

Practice location:
  • Phone: 785-966-8200
  • Fax: 785-966-8393
Mailing address:
  • Phone: 785-966-8200
  • Fax: 785-966-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10538
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: