Healthcare Provider Details

I. General information

NPI: 1184530602
Provider Name (Legal Business Name): INTEGRA COUNSELING AND PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26271 W CEDAR NILES CIR
OLATHE KS
66061-7471
US

IV. Provider business mailing address

10600 E 35TH TER S
INDEPENDENCE MO
64052-1114
US

V. Phone/Fax

Practice location:
  • Phone: 816-682-5955
  • Fax:
Mailing address:
  • Phone: 816-682-5955
  • 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: LAURA LEA WISDOM
Title or Position: OWNER AND COUNSELOR
Credential: LPC 2856 KS
Phone: 816-682-5955