Healthcare Provider Details

I. General information

NPI: 1912811811
Provider Name (Legal Business Name): JONATHON LEE FANCHER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 METCALF AVE STE 105
OVERLAND PARK KS
66213-2828
US

IV. Provider business mailing address

4110 W 157TH TER
OVERLAND PARK KS
66224-3529
US

V. Phone/Fax

Practice location:
  • Phone: 913-359-8709
  • Fax:
Mailing address:
  • Phone: 608-609-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05584
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: