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General NPI Number Information
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NPI Number | 1972928752
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Entity Type | Individual
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Provider Name | MANDY AYCOCK LPC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 2317 N 86TH TER
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City | KANSAS CITY
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State | KS
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Zip | 66109-2059
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Country | US
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Telephone | 913-638-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 N 86TH TER
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City | KANSAS CITY
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State | KS
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Zip | 66109-2059
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Country | US
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Telephone | 913-638-1246
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2556
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License Number State | KS
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