Healthcare Provider Details

I. General information

NPI: 1487139887
Provider Name (Legal Business Name): LAURA WEAVER LPC, NCC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N MUR LEN RD STE 6
OLATHE KS
66062-5416
US

IV. Provider business mailing address

601 N MUR LEN RD STE 6
OLATHE KS
66062-5416
US

V. Phone/Fax

Practice location:
  • Phone: 816-590-9828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3310
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3310
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3310
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: