Healthcare Provider Details

I. General information

NPI: 1295177814
Provider Name (Legal Business Name): KIDSTLC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S ROGERS RD
OLATHE KS
66062-1704
US

IV. Provider business mailing address

480 S ROGERS RD
OLATHE KS
66062-1706
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-2887
  • Fax: 913-780-3387
Mailing address:
  • Phone: 913-764-2887
  • Fax: 913-780-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1084035
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1073899
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1084035
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1073899
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1084035
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1073899
License Number StateMO

VIII. Authorized Official

Name: MARY THOMAS
Title or Position: CFO
Credential:
Phone: 913-324-3681