Provider Demographics
NPI:1215379201
Name:TACEY, JANEEN FAITH (LMLP-T)
Entity Type:Individual
Prefix:
First Name:JANEEN
Middle Name:FAITH
Last Name:TACEY
Suffix:
Gender:F
Credentials:LMLP-T
Other - Prefix:
Other - First Name:JANEEN
Other - Middle Name:FAITH
Other - Last Name:STUTHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 NW REDBUD CIR
Mailing Address - Street 2:7
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617-1882
Mailing Address - Country:US
Mailing Address - Phone:402-649-4288
Mailing Address - Fax:
Practice Address - Street 1:235 S KANSAS AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3616
Practice Address - Country:US
Practice Address - Phone:785-409-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical