1336337021 NPI number — JANET CLEVENGER LCMFT, LMFT

Table of content: JANET CLEVENGER LCMFT, LMFT (NPI 1336337021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336337021 NPI number — JANET CLEVENGER LCMFT, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEVENGER
Provider First Name:
JANET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMFT, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEVENGER-ALLEN
Provider Other First Name:
JANET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCMFT, LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336337021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11111 NALL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 219
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-284-0472
Provider Business Practice Location Address Fax Number:
913-284-0473
Provider Enumeration Date:
10/09/2007

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:  2021022116 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 758 , 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: 42376019 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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