1629321369 NPI number — CARRON ELLSPERMANN MONTGOMERY LPC, RPT

Table of content: CARRON ELLSPERMANN MONTGOMERY LPC, RPT (NPI 1629321369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629321369 NPI number — CARRON ELLSPERMANN MONTGOMERY LPC, RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
CARRON
Provider Middle Name:
ELLSPERMANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629321369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9915 ENSLEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66206-2460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-515-6927
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-338-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  2436 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)