Healthcare Provider Details

I. General information

NPI: 1508154725
Provider Name (Legal Business Name): ANDREW R DILLINGHAM LCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDY DILLINGHAM

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 15TH ST
PLEASANTON KS
66075-4095
US

IV. Provider business mailing address

PO BOX 807 304 N. JEFFERSON AVE
IOLA KS
66749-2327
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8214
  • Fax:
Mailing address:
  • Phone: 620-365-8641
  • Fax: 620-365-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1453
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: