Healthcare Provider Details

I. General information

NPI: 1073811659
Provider Name (Legal Business Name): GEORGIA FRANGOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 SUMMIT CT
SHAWNEE KS
66216-5101
US

IV. Provider business mailing address

5412 SUMMIT CT
SHAWNEE KS
66216-5101
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-7595
  • Fax:
Mailing address:
  • Phone: 620-663-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1385
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: