Provider Demographics
NPI:1053660142
Name:GLENDA RODGERS-LAWLESS, PH.D., LCPC, PA
Entity Type:Organization
Organization Name:GLENDA RODGERS-LAWLESS, PH.D., LCPC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODGERS-LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-553-7858
Mailing Address - Street 1:4601 E DOUGLAS
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218
Mailing Address - Country:US
Mailing Address - Phone:316-337-5530
Mailing Address - Fax:316-337-5531
Practice Address - Street 1:4601 E DOUGLAS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:316-337-5530
Practice Address - Fax:316-337-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC 275251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200428700AMedicaid