1396887519 NPI number — MRS. DEBRA JEANETTE HARTLEY LSCSW

Table of content: MRS. DEBRA JEANETTE HARTLEY LSCSW (NPI 1396887519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396887519 NPI number — MRS. DEBRA JEANETTE HARTLEY LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTLEY
Provider First Name:
DEBRA
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COURTNEY
Provider Other First Name:
DEBRA
Provider Other Middle Name:
JEANETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396887519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8400 W 110TH
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-491-3460
Provider Business Mailing Address Fax Number:
913-491-1141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 W 110TH
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-491-3460
Provider Business Practice Location Address Fax Number:
913-491-1141
Provider Enumeration Date:
02/13/2007

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: 104100000X , with the licence number:  998LSCSW , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: LSCSW2005038977 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100289830A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com