Provider Demographics
NPI:1578685467
Name:SCHMIDT, LISA C (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:C
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14161 W 114TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4850
Mailing Address - Country:US
Mailing Address - Phone:913-451-1917
Mailing Address - Fax:
Practice Address - Street 1:800 S 55TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-1308
Practice Address - Country:US
Practice Address - Phone:913-288-4180
Practice Address - Fax:913-288-3480
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702278101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool