MEDICARE: MRS. LINDA SUE STANLEY LMFT, AAPS

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	561	KS

General Provider Information

NPI Number	:	1821217647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA SUE STANLEY LMFT, AAPS

Provider Business Mailing Address
First Line	:	5927 HEMLOCK DR
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-6409
Country	:	US
Telephone Number	:	620-793-6380
Fax Number	:	620-793-7370

Provider Business Practice Location Address
First Line	:	1508 MAIN ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-4007
Country	:	US
Telephone Number	:	620-757-8224
Fax Number	:	620-793-7370

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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