Provider Demographics
NPI:1104210541
Name:WOODWARD, CHRIS (LCAC)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S CLAIRBORNE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1744
Mailing Address - Country:US
Mailing Address - Phone:913-648-2266
Mailing Address - Fax:855-348-3430
Practice Address - Street 1:407 S CLAIRBORNE RD STE 207
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-276-7010
Practice Address - Fax:855-348-3430
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00852101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200408400AMedicaid