Healthcare Provider Details

I. General information

NPI: 1104210541
Provider Name (Legal Business Name): CHRIS WOODWARD LCAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S CLAIRBORNE RD STE 207
OLATHE KS
66062-1744
US

IV. Provider business mailing address

407 S CLAIRBORNE RD STE 207
OLATHE KS
66062-1744
US

V. Phone/Fax

Practice location:
  • Phone: 913-276-7010
  • Fax: 855-348-3430
Mailing address:
  • Phone: 913-648-2266
  • Fax: 855-348-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00852
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: