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General NPI Number Information
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NPI Number | 1255815874
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Entity Type | Organization
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Legal Business Name | ACCOMPLISHKC
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 2108 W 75TH ST STE D
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3504
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Country | US
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Telephone | 913-543-1707
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Fax |
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Provider Business Mailing Address
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Address Line | 4517 W 75TH ST
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-4378
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Country | US
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Telephone | 913-302-1773
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Fax |
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Authorized Official
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Title or Position | CLINICAL CONSULTANT 1
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Name | ETIENNE CLATANOFF
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Credential | LPC, LPCP
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Telephone | 913-302-1773
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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