1174837835 NPI number — MR. RICHARD LEE PRESLEY M.S. LCMFT

Table of content: MR. RICHARD LEE PRESLEY M.S. LCMFT (NPI 1174837835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174837835 NPI number — MR. RICHARD LEE PRESLEY M.S. LCMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESLEY
Provider First Name:
RICHARD
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S. LCMFT
Provider Gender Code:
M

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:
1174837835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12710 S PFLUMM RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66062-3882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-738-4757
Provider Business Mailing Address Fax Number:
913-440-4434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12710 S PFLUMM RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-3882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-738-4757
Provider Business Practice Location Address Fax Number:
913-440-4434
Provider Enumeration Date:
08/04/2010

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: 106H00000X , with the licence number:  832 , 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)

  • Identifier: 200665480A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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