Provider Demographics
NPI:1043617152
Name:THENO, LAURA (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:THENO
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:N
Other - Last Name:GIBBENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5736 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3997
Mailing Address - Country:US
Mailing Address - Phone:816-307-0562
Mailing Address - Fax:
Practice Address - Street 1:5734 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3997
Practice Address - Country:US
Practice Address - Phone:816-866-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2704101YP2500X
KS2548101YP2500X
MO2017031254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional