=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275838351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOTHERAPY CONSULTANTS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2011
-----------------------------------------------------
Last Update Date | 01/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13626 W 95TH ST
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66215-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-620-8111
-----------------------------------------------------
Fax | 913-541-8030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2813 W 51ST ST
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66205-1748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-620-8111
-----------------------------------------------------
Fax | 913-722-7839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN BROOKS-HART
-----------------------------------------------------
Credential | LSCSW
-----------------------------------------------------
Telephone | 913-620-8111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1719
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1719
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------