Provider Demographics
NPI:1508388778
Name:NOTEBOOM-HENDERSON, TIFFANY (LMSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NOTEBOOM-HENDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 LAMAR AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3234
Mailing Address - Country:US
Mailing Address - Phone:913-826-4200
Mailing Address - Fax:913-826-1589
Practice Address - Street 1:6000 LAMAR AVE STE 130
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3234
Practice Address - Country:US
Practice Address - Phone:913-826-4200
Practice Address - Fax:913-826-1589
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker