Healthcare Provider Details

I. General information

NPI: 1326935644
Provider Name (Legal Business Name): MICHAEL JANZEN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST STE 156
NEWTON KS
67114-2211
US

IV. Provider business mailing address

91 S ROUPP ST
HESSTON KS
67062-9032
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14209
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14209
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: