Provider Demographics
NPI:1508915745
Name:REES, MARY MARTHA (LSCSW LCMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARTHA
Last Name:REES
Suffix:
Gender:F
Credentials:LSCSW LCMFT
Other - Prefix:
Other - First Name:MARTI
Other - Middle Name:
Other - Last Name:REES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSCSW
Mailing Address - Street 1:8400 W 110TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-491-3460
Mailing Address - Fax:913-491-1141
Practice Address - Street 1:8400 W 110TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-491-3460
Practice Address - Fax:913-491-1141
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS542104100000X
KS147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSLCMFT147OtherREGULATORY BOARD
KSLSCSW542OtherBEHAVIORAL SCIENCES
C792315Medicare ID - Type Unspecified