MEDICARE: SHEA WITHERSPOON LSCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	00935	KS
2	1041C0700X	Clinical Social Worker	0700	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00935	OTHER	KS	LCAC

General Provider Information

NPI Number	:	1114651361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA WITHERSPOON LSCSW

Provider Business Mailing Address
First Line	:	2140 E CHARLESTON DR
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1702
Country	:	US
Telephone Number	:	316-204-0369
Fax Number	:

Provider Business Practice Location Address
First Line	:	10209 W CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-4684
Country	:	US
Telephone Number	:	316-204-0369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	03/12/2026

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Directions to “ SHEA WITHERSPOON LSCSW” Practice Location

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