Healthcare Provider Details

I. General information

NPI: 1497665301
Provider Name (Legal Business Name): SEAN KIRK LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 RICHARDS DR
SHAWNEE KS
66216-1724
US

IV. Provider business mailing address

130 E 5TH ST
NEWTON KS
67114-2206
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-1943
  • Fax:
Mailing address:
  • Phone: 316-283-6743
  • Fax: 316-283-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number09353
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02071-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: