Provider Demographics
NPI:1053825547
Name:MUNDIS, CURT BRECKENRIDGE (LMSW)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:BRECKENRIDGE
Last Name:MUNDIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:BRECK
Other - Middle Name:
Other - Last Name:MUNDIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:10024 W 118TH TER APT 301
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3100
Mailing Address - Country:US
Mailing Address - Phone:816-682-8065
Mailing Address - Fax:
Practice Address - Street 1:11011 KING ST STE 237
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-3210
Practice Address - Country:US
Practice Address - Phone:913-735-9433
Practice Address - Fax:913-871-3133
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker