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General NPI Number Information
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NPI Number | 1083395057
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Entity Type | Organization
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Legal Business Name | COUNSELING & THERAPEUTIC SERVICES OF JOHNSON CO LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 11900 W 87TH STREET PKWY STE 130
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City | LENEXA
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State | KS
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Zip | 66215-4517
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Country | US
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Telephone | 913-963-9990
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Fax | 816-227-6931
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Provider Business Mailing Address
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Address Line | 8818 GOLDEN LN
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City | DE SOTO
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State | KS
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Zip | 66018-7501
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Country | US
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Telephone | 913-963-9990
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Fax | 816-227-6931
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Authorized Official
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Title or Position | OWNER
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Name | LARA WISDOM
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Credential | LCPC
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Telephone | 913-963-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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