Healthcare Provider Details

I. General information

NPI: 1639803489
Provider Name (Legal Business Name): RACHEL NICOLE GRGURICH MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 BARKLEY ST STE 106
OVERLAND PARK KS
66212-1890
US

IV. Provider business mailing address

10551 BARKLEY ST STE 106
OVERLAND PARK KS
66212-1890
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-7510
  • Fax:
Mailing address:
  • Phone: 913-735-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number04098
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: