Healthcare Provider Details

I. General information

NPI: 1720943277
Provider Name (Legal Business Name): JESSE STANLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 BARKLEY ST STE 120
OVERLAND PARK KS
66211-1162
US

IV. Provider business mailing address

5920 REEDS RD APT 102
MISSION KS
66202-3445
US

V. Phone/Fax

Practice location:
  • Phone: 913-850-1037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05238
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: