Provider Demographics
NPI:1609124718
Name:BANWART, ALAN D (LSCSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:BANWART
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7839 W 197TH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9508
Mailing Address - Country:US
Mailing Address - Phone:816-589-1058
Mailing Address - Fax:888-389-5175
Practice Address - Street 1:14221 METCALF AVE STE 119
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3301
Practice Address - Country:US
Practice Address - Phone:913-353-6053
Practice Address - Fax:888-389-5175
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43181041C0700X
MO2011025106104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200653410DMedicaid