Provider Demographics
NPI:1124019708
Name:STOOPS, BRENDA KAY LEE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY LEE
Last Name:STOOPS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-0688
Mailing Address - Country:US
Mailing Address - Phone:620-331-1748
Mailing Address - Fax:620-332-1940
Practice Address - Street 1:3751 W MAIN ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-8446
Practice Address - Country:US
Practice Address - Phone:620-331-1748
Practice Address - Fax:620-332-1940
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001280A101YM0800X
KSLCPC2402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN17515OtherPARTNERS HEALTH PLAN
IN4431OtherIUPM
IN200447760BMedicaid
IN480586Medicare UPIN
IN30898Medicare UPIN
IN4675Medicare UPIN
IN304655Medicare UPIN
IN7428494Medicare UPIN
IN17515OtherPARTNERS HEALTH PLAN
IN216122297Medicare UPIN
IN456240000Medicare UPIN
IN4431OtherIUPM
IN2157390Medicare UPIN
IN13463Medicare UPIN
IN00000032809Medicare UPIN
IN200447760BMedicaid