| Boulevard Psychology, Llc | |
|
6240 W 135th St Ste 200 Overland Park KS 66223-4849 | |
| (913) 499-4302 | |
| (913) 308-0880 |
| Full Name | Boulevard Psychology, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 6240 W 135th St Ste 200, Overland Park, Kansas |
| Authorized Official Name and Position | Wendy Susan Eaves (MANAGING MEMBER) |
| Authorized Official Contact | 9134994302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulevard Psychology, Llc 6240 W 135th St Ste 200 Overland Park KS 66223-4849 Ph: (913) 499-4302 | Boulevard Psychology, Llc 6240 W 135th St Ste 200 Overland Park KS 66223-4849 Ph: (913) 499-4302 |
| NPI Number | 1508085291 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 11/29/2022 |
| Certification Date | 11/29/2022 |
| Medicare PECOS PAC ID | 6103858261 |
|---|---|
| Medicare Enrollment ID | O20050909000165 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508085291 | NPI | - | NPPES |
| 19320048 | Other | KS | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | KS 811 (Kansas) | Primary |
| Provider Name | Wendy S Eaves |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770596892 PECOS PAC ID: 2163454224 Enrollment ID: I20050909000224 |
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