Healthcare Provider Details

I. General information

NPI: 1912369026
Provider Name (Legal Business Name): SEAN RYAN O'DANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST STE 156&215
NEWTON KS
67114-2200
US

IV. Provider business mailing address

500 N MAIN ST STE 156&215
NEWTON KS
67114-2200
US

V. Phone/Fax

Practice location:
  • Phone: 316-202-4414
  • Fax:
Mailing address:
  • Phone: 316-202-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05540
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: