Provider Demographics
NPI:1467874248
Name:PISCIOTTA, LAURIE (LCMFT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:PISCIOTTA
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 W 110TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2620
Mailing Address - Country:US
Mailing Address - Phone:816-645-2215
Mailing Address - Fax:
Practice Address - Street 1:8575 W 110TH ST STE 225
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2620
Practice Address - Country:US
Practice Address - Phone:816-645-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201099780BMedicaid