Healthcare Provider Details

I. General information

NPI: 1093539405
Provider Name (Legal Business Name): MR. MARVIN KEITH MEEKS II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 W 110TH ST # 145
OVERLAND PARK KS
66210-2331
US

IV. Provider business mailing address

12919 BALLENTINE ST
OVERLAND PARK KS
66213-3490
US

V. Phone/Fax

Practice location:
  • Phone: 913-214-2022
  • Fax:
Mailing address:
  • Phone: 214-592-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC04662-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: