Provider Demographics
NPI:1558139097
Name:STITES, JIM (LPC)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:STITES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:STITES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:5003 W 70TH TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8900 STATE LINE RD STE 455
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1943
Practice Address - Country:US
Practice Address - Phone:913-424-7942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional