Healthcare Provider Details

I. General information

NPI: 1740522721
Provider Name (Legal Business Name): KRISTINE ANN PAGE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 S BLACKBOB RD
OLATHE KS
66062-4901
US

IV. Provider business mailing address

11515 S BLACKBOB RD
OLATHE KS
66062-4901
US

V. Phone/Fax

Practice location:
  • Phone: 913-952-6027
  • Fax:
Mailing address:
  • Phone: 913-952-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2487
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103057
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2506
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: