Healthcare Provider Details

I. General information

NPI: 1194341404
Provider Name (Legal Business Name): AUTISM & DEVELOPMENTAL YOUTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 S MUR-LEN RD SUITE 105
OLATHE KS
66062
US

IV. Provider business mailing address

9105 W 95TH TERR
OVERLAND PARK KS
66212
US

V. Phone/Fax

Practice location:
  • Phone: 913-390-3330
  • Fax:
Mailing address:
  • Phone: 913-390-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JULIE IMANI FRANCHETT
Title or Position: CO-OWNER/VICE PRESIDENT
Credential: LCP
Phone: 913-390-3330