| Lifestance Health | |
|
8400 W 110th St. Ste 100 Overland Park KS 66210-2307 | |
| (913) 327-7505 | |
| (216) 456-8128 |
| Full Name | Lifestance Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8400 W 110th St., Overland Park, Kansas |
| Authorized Official Name and Position | Ryan B Pardo (CHIEF LEGAL OFFICER) |
| Authorized Official Contact | 4252798500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestance Health 25101 Chagrin Blvd Ste 100 Beachwood OH 44122-5694 Ph: (253) 346-0392 | Lifestance Health 8400 W 110th St. Ste 100 Overland Park KS 66210-2307 Ph: (913) 327-7505 |
| NPI Number | 1114096385 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 10/03/2023 |
| Certification Date | 10/03/2023 |
| Medicare PECOS PAC ID | 6507881422 |
|---|---|
| Medicare Enrollment ID | O20051011000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114096385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Ethan E Bickelhaupt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760427389 PECOS PAC ID: 5991746059 Enrollment ID: I20050518001116 |
| Provider Name | Andrew I Whitmore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306916077 PECOS PAC ID: 1557556834 Enrollment ID: I20170830001579 |
| Provider Name | Payam Mokhtari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619316759 PECOS PAC ID: 5496052920 Enrollment ID: I20170914003596 |
| Provider Name | Monty Wayne Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689711582 PECOS PAC ID: 7618237934 Enrollment ID: I20190102000024 |
| Provider Name | Anaya T Kole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063066637 PECOS PAC ID: 8921435710 Enrollment ID: I20200217000387 |
| Provider Name | Tina N Hendrix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760113229 PECOS PAC ID: 3476920869 Enrollment ID: I20221027000835 |
| Provider Name | Victoria Garcia Bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700585486 PECOS PAC ID: 5799130910 Enrollment ID: I20231009001122 |
| Provider Name | Julia Ann Myers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255022802 PECOS PAC ID: 7012363450 Enrollment ID: I20231021000351 |
| Provider Name | Karen L. Pulcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124450127 PECOS PAC ID: 8820444268 Enrollment ID: I20231021000410 |
| Provider Name | Laura Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689349243 PECOS PAC ID: 7810372083 Enrollment ID: I20231021000456 |
| Provider Name | Jeffrey Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073826962 PECOS PAC ID: 4284891607 Enrollment ID: I20231021000498 |
| Provider Name | Laura Faye Tieszen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447939921 PECOS PAC ID: 6103276936 Enrollment ID: I20231220001132 |
| Provider Name | Jerry Morris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831170034 PECOS PAC ID: 1456519750 Enrollment ID: I20240301002729 |
| Provider Name | Claire Becker-horneker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669103776 PECOS PAC ID: 0244676856 Enrollment ID: I20240306000319 |
| Provider Name | Connor Kyle Oshea |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346819877 PECOS PAC ID: 8921444324 Enrollment ID: I20240307002488 |
| Provider Name | Rebecca J Reising |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982733010 PECOS PAC ID: 6709222110 Enrollment ID: I20240307003174 |
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