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General NPI Number Information
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NPI Number | 1154537488
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Entity Type | Individual
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Provider Name | KRISTY MCCOLLUM-WACHTER
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 11120 W 65TH ST
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City | SHAWNEE
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State | KS
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Zip | 66203-5504
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Country | US
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Telephone | 913-826-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 LAMAR AVE STE 1300
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City | MISSION
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State | KS
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Zip | 66202-3234
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Country | US
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Telephone | 913-826-4200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 176
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License Number State | KS
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