Healthcare Provider Details

I. General information

NPI: 1003735101
Provider Name (Legal Business Name): SHANA PARKER LSCSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11647 S MIZE RD
OLATHE KS
66061-7680
US

IV. Provider business mailing address

11647 S MIZE RD
OLATHE KS
66061-7680
US

V. Phone/Fax

Practice location:
  • Phone: 913-302-2385
  • Fax:
Mailing address:
  • Phone: 913-302-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5220
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010012034
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: