Healthcare Provider Details

I. General information

NPI: 1992621304
Provider Name (Legal Business Name): MAXIMILIAN JOHN THOOFT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S CLAIRBORNE RD STE 200
OLATHE KS
66062-1735
US

IV. Provider business mailing address

9748 W 86TH ST APT D
OVERLAND PARK KS
66212-4543
US

V. Phone/Fax

Practice location:
  • Phone: 651-592-0352
  • Fax:
Mailing address:
  • Phone: 651-592-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05437
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: