Provider Demographics
NPI:1548417264
Name:HARRIS, SUSAN H (LSCSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10965 GRANADA LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-484-8674
Mailing Address - Fax:913-451-7520
Practice Address - Street 1:10965 GRANADA LN
Practice Address - Street 2:SUITE 103
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1401
Practice Address - Country:US
Practice Address - Phone:913-484-8674
Practice Address - Fax:913-451-7520
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS36421041C0700X
MO20060327911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical