Healthcare Provider Details

I. General information

NPI: 1346166410
Provider Name (Legal Business Name): JARETH DEL REAL LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 COLLEGE BLVD
OVERLAND PARK KS
66210-1978
US

IV. Provider business mailing address

1010 E HUNTINGTON PL
OLATHE KS
66061-3529
US

V. Phone/Fax

Practice location:
  • Phone: 913-213-1510
  • Fax:
Mailing address:
  • Phone: 913-636-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07217
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: