Provider Demographics
NPI:1508179243
Name:AHRENDT, TREVOR MAXWELL (MA)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:MAXWELL
Last Name:AHRENDT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SCHWEGLER DR
Mailing Address - Street 2:ROOM 2100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7558
Mailing Address - Country:US
Mailing Address - Phone:785-864-2277
Mailing Address - Fax:
Practice Address - Street 1:1200 SCHWEGLER DR
Practice Address - Street 2:ROOM 2100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7558
Practice Address - Country:US
Practice Address - Phone:785-864-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KST-LMLP 2423103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health