Healthcare Provider Details

I. General information

NPI: 1174469464
Provider Name (Legal Business Name): MADISON LEA COURSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 INDIAN CREEK PKWY STE 102
OLATHE KS
66062-1215
US

IV. Provider business mailing address

504 E 3RD ST
OTTAWA KS
66067-2415
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-9942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: