Provider Demographics
NPI:1033261664
Name:MEANS, ANTIGONE MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:ANTIGONE
Middle Name:MARIE
Last Name:MEANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANTIGONE
Other - Middle Name:MARIE
Other - Last Name:MEANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:304 N JEFFERSON
Mailing Address - Street 2:PO BOX 807
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749
Mailing Address - Country:US
Mailing Address - Phone:620-365-5717
Mailing Address - Fax:620-365-8255
Practice Address - Street 1:304 N JEFFERSON
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749
Practice Address - Country:US
Practice Address - Phone:620-365-5717
Practice Address - Fax:620-365-8255
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119766OtherBLUE SHIELD
KS119766Medicare ID - Type Unspecified