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General NPI Number Information
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NPI Number | 1508085291
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Entity Type | Organization
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Legal Business Name | BOULEVARD PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 6240 W 135TH ST STE 200
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City | OVERLAND PARK
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State | KS
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Zip | 66223-4849
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Country | US
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Telephone | 913-499-4302
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Fax | 913-308-0880
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Provider Business Mailing Address
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Address Line | 6240 W 135TH ST STE 200
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City | OVERLAND PARK
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State | KS
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Zip | 66223-4849
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Country | US
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Telephone | 913-499-4302
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Fax | 913-499-4304
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. WENDY SUSAN EAVES
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Credential | PHD
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Telephone | 913-499-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | KS 811
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License Number State | KS
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