Healthcare Provider Details

I. General information

NPI: 1770596892
Provider Name (Legal Business Name): WENDY S. EAVES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 W 135TH ST STE 200
OVERLAND PARK KS
66223-4849
US

IV. Provider business mailing address

6240 W 135TH ST STE 200
OVERLAND PARK KS
66223-4849
US

V. Phone/Fax

Practice location:
  • Phone: 913-499-4302
  • Fax: 913-308-0880
Mailing address:
  • Phone: 913-499-4302
  • Fax: 913-499-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberKS 811
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: