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NPI Code Detail

MEDICARE: KIDSTLC, INC.

MEDICARE: KIDSTLC, INC.
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
1251S00000XCommunity/Behavioral Health Agency1084035MO
2103K00000XBehavior Analyst1073899MO
3171M00000XCase Manager/Care Coordinator1084035MO
4171M00000XCase Manager/Care Coordinator1073899MO
5251S00000XCommunity/Behavioral Health Agency1073899MO
6103K00000XBehavior Analyst1084035MO

General Provider Information

NPI Number : 1295177814
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDSTLC, INC.
Provider Business Mailing Address
First Line : 480 S ROGERS RD
Second Line :
City : OLATHE
State : KS
Zip : 66062-1706
Country : US
Telephone Number : 913-764-2887
Fax Number : 913-780-3387
Provider Business Practice Location Address
First Line : 620 S ROGERS RD
Second Line :
City : OLATHE
State : KS
Zip : 66062-1704
Country : US
Telephone Number : 913-764-2887
Fax Number : 913-780-3387
Authorized Official
Title or Position : CFO
Name : MARY THOMAS
Credential :
Telephone Number : 913-324-3681
Provider Enumeration Date : 07/24/2013
Last Update Date : 07/15/2021

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1952251530 — ABIGAIL MARIE ENGLERT
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620 S ROGERS RD
OLATHE, KS
66062-1704
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1245404821 — TRACY LYNNE SCHMITT LBA
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1275829814 — LAUREN W BINGHAM BCABA
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66062-1704
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1245673185 — BETTY JOAN JOHNSON
Practice Location Address:
620 S ROGERS RD
OLATHE, KS
66062-1704
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Practice Fax:
1437583168 — MRS. DANIELLE M JOHNSON PHD
Practice Location Address:
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OLATHE, KS
66062-1704
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1780014480 — KIDSTLC, INC
Practice Location Address:
620 S ROGERS RD
OLATHE, KS
66062-1704
Practice Phone: 913-324-3823
Practice Fax: 913-780-3387

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