Provider Demographics
NPI:1063495992
Name:LITTLE, LEONARD MICHAEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:MICHAEL
Last Name:LITTLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5401 COLLEGE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1617
Mailing Address - Country:US
Mailing Address - Phone:913-339-6838
Mailing Address - Fax:913-764-4160
Practice Address - Street 1:5401 COLLEGE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1617
Practice Address - Country:US
Practice Address - Phone:913-339-6838
Practice Address - Fax:913-764-4160
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00953103TC0700X
KS0542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2040124OtherMEDICARE