Healthcare Provider Details

I. General information

NPI: 1265256879
Provider Name (Legal Business Name): INDIAN CREEK PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15022 W 128TH ST
OLATHE KS
66062-5809
US

IV. Provider business mailing address

15022 W 128TH ST
OLATHE KS
66062-5809
US

V. Phone/Fax

Practice location:
  • Phone: 913-636-5657
  • Fax: 913-395-0562
Mailing address:
  • Phone: 913-636-5657
  • Fax: 913-395-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH LEE MORRIS
Title or Position: PRESIDENT
Credential: ED.D., L.C.P.C.
Phone: 913-636-5657