Provider Demographics
NPI:1174021745
Name:NDANGO, LAWRENCE LANYEGHA
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:LANYEGHA
Last Name:NDANGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SE 5TH TER
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1057
Mailing Address - Country:US
Mailing Address - Phone:816-419-1294
Mailing Address - Fax:
Practice Address - Street 1:2305 SE 5TH TER
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1057
Practice Address - Country:US
Practice Address - Phone:816-419-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities