Healthcare Provider Details

I. General information

NPI: 1467688309
Provider Name (Legal Business Name): SUSAN MARIE EDWARDS MA, LCPC, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MONROE ST
OLATHE KS
66061-3162
US

IV. Provider business mailing address

301 N MONROE ST
OLATHE KS
66061-3162
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-0283
  • Fax: 913-826-1589
Mailing address:
  • Phone: 913-782-0283
  • Fax: 913-826-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number397
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000174744
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2247
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: