Healthcare Provider Details

I. General information

NPI: 1063873206
Provider Name (Legal Business Name): BETHANY VROOM LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 LAMAR AVE STE 100
MERRIAM KS
66202-4284
US

IV. Provider business mailing address

12409 E 56TH ST
KANSAS CITY MO
64133-3097
US

V. Phone/Fax

Practice location:
  • Phone: 816-288-2918
  • Fax:
Mailing address:
  • Phone: 816-651-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015016657
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCPC
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2618
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: