Healthcare Provider Details

I. General information

NPI: 1104556828
Provider Name (Legal Business Name): AVERY MIELKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 INDIAN CREEK PKWY STE 380
OVERLAND PARK KS
66210-2008
US

IV. Provider business mailing address

16007 W 160TH ST
OLATHE KS
66062-3191
US

V. Phone/Fax

Practice location:
  • Phone: 913-522-3917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number01562
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: