Provider Demographics
NPI:1568740413
Name:LARRY L LEE, LSCSW
Entity Type:Organization
Organization Name:LARRY L LEE, LSCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-734-5670
Mailing Address - Street 1:1440 TAPESTRY LN
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-9337
Mailing Address - Country:US
Mailing Address - Phone:316-734-5670
Mailing Address - Fax:316-550-6380
Practice Address - Street 1:1440 TAPESTRY LN
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-9337
Practice Address - Country:US
Practice Address - Phone:316-734-5670
Practice Address - Fax:316-550-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2003 LSCSW251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100458440AMedicaid
KS1255329488OtherTYPE I NPI 1255329488
KS100458440AMedicaid