MEDICARE: JANET CLEVENGER LCMFT, LMFT

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	106H00000X	Marriage & Family Therapist	2021022116	MO
2	106H00000X	Marriage & Family Therapist	758	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42376019	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336337021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET CLEVENGER LCMFT, LMFT

Provider Business Mailing Address
First Line	:	11111 NALL AVE.
Second Line	:	SUITE 219
City	:	LEAWOOD
State	:	KS
Zip	:	66211
Country	:	US
Telephone Number	:	913-284-0472
Fax Number	:	913-284-0473

Provider Business Practice Location Address
First Line	:	11111 NALL AVENUE
Second Line	:	SUITE 219
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1625
Country	:	US
Telephone Number	:	913-284-0472
Fax Number	:	913-284-0473

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	01/26/2023

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