Healthcare Provider Details

I. General information

NPI: 1700389608
Provider Name (Legal Business Name): XINLI FAN LMFT, LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 NE RICE RD
LEES SUMMIT MO
64086-5849
US

IV. Provider business mailing address

6510 E 128TH TER
GRANDVIEW MO
64030-1923
US

V. Phone/Fax

Practice location:
  • Phone: 816-966-0900
  • Fax: 816-347-3200
Mailing address:
  • Phone: 913-228-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03120
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2022011310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: