Provider Demographics
NPI:1437468345
Name:TERESA REICHART-VERNON, LSCSW LLC
Entity Type:Organization
Organization Name:TERESA REICHART-VERNON, LSCSW LLC
Other - Org Name:TERESA REICHART-VERNON, LSCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHART-VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:913-207-7674
Mailing Address - Street 1:10601 KAW DR
Mailing Address - Street 2:STE. B
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1130
Mailing Address - Country:US
Mailing Address - Phone:913-207-7674
Mailing Address - Fax:913-745-8040
Practice Address - Street 1:10601 KAW DR
Practice Address - Street 2:STE. B
Practice Address - City:EDWARDSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66111-1130
Practice Address - Country:US
Practice Address - Phone:913-207-7674
Practice Address - Fax:913-745-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 1463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS513729271OtherMHNET
KS831649000OtherMAGELLAN
KS513729271OtherPHP
KS513729271OtherWELLPOINT
KS100079970CMedicaid
KS36520013OtherBLUE CROSS BLUE SHIELD
KS513729271OtherCOVENTRY/FIRST HEALTH
KSREICHART-VERNONOtherENI/BMH
KS513729271OtherUBH
KS513729271OtherTRICARE
KS513729271OtherAPS
KS513729271OtherLIFESYNCH
KS563233OtherVALUEOPTIONS
KSREICHART-VERNONOtherENI/BMH