| Kidstlc, Inc. | |
|
480 S Rogers Rd Olathe KS 66062-1706 | |
| (913) 764-2887 | |
| (913) 780-3387 |
| Full Name | Kidstlc, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 480 S Rogers Rd, Olathe, Kansas |
| Authorized Official Name and Position | Mary Thomas (CFO) |
| Authorized Official Contact | 9133243681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidstlc, Inc. 480 S Rogers Rd Olathe KS 66062-1706 Ph: (913) 764-2887 | Kidstlc, Inc. 480 S Rogers Rd Olathe KS 66062-1706 Ph: (913) 764-2887 |
| NPI Number | 1528183381 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 07/07/2021 |
| Certification Date | 07/07/2021 |
| Medicare PECOS PAC ID | 6901124064 |
|---|---|
| Medicare Enrollment ID | O20160324000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528183381 | NPI | - | NPPES |
| 100007420 A | Medicaid | KS | |
| 100007420C | Medicaid | KS | |
| 100007420B | Medicaid | KS |
| Provider Name | Lucinda J Whitney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316052723 PECOS PAC ID: 5991935959 Enrollment ID: I20140313001212 |
| Provider Name | Danielle M Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437583168 PECOS PAC ID: 9830496116 Enrollment ID: I20160331001681 |
| Provider Name | Shanna K Crowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952789653 PECOS PAC ID: 7113209842 Enrollment ID: I20170112002557 |
| Provider Name | Kara Lynn Haney-wiltz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538397088 PECOS PAC ID: 1951669761 Enrollment ID: I20171228001751 |
| Provider Name | Christine Elizabeth Fuhrman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174802052 PECOS PAC ID: 0941558480 Enrollment ID: I20180731003041 |
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