Provider Demographics
NPI:1417008657
Name:FANGMAN, ELMER (LPC)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:
Last Name:FANGMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-1407
Mailing Address - Country:US
Mailing Address - Phone:913-367-2688
Mailing Address - Fax:
Practice Address - Street 1:1225 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1401
Practice Address - Country:US
Practice Address - Phone:913-367-0105
Practice Address - Fax:913-367-0105
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC 0217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSLPC 0217OtherLICENSED PROFESSIONAL COU