Healthcare Provider Details

I. General information

NPI: 1154821346
Provider Name (Legal Business Name): AUDRA NICOLE VANMATRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 W 95TH ST STE 220
OVERLAND PARK KS
66212-6195
US

IV. Provider business mailing address

6400 W 110TH ST STE 202
OVERLAND PARK KS
66211-1585
US

V. Phone/Fax

Practice location:
  • Phone: 913-346-1516
  • Fax:
Mailing address:
  • Phone: 816-607-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025004023
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03548
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: