Provider Demographics
NPI:1568523785
Name:BENTLEY, KARYN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:D
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11184 ANTIOCH RD
Mailing Address - Street 2:STE 316
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2420
Mailing Address - Country:US
Mailing Address - Phone:913-663-1502
Mailing Address - Fax:913-663-1722
Practice Address - Street 1:11184 ANTIOCH RD
Practice Address - Street 2:STE 316
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2420
Practice Address - Country:US
Practice Address - Phone:913-663-1502
Practice Address - Fax:913-663-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1195103TC0700X
MO2002030472103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000D826AMedicare ID - Type Unspecified
KS000D826Medicare ID - Type Unspecified