Provider Demographics
NPI:1609274430
Name:AUTISM, BEHAVIOR, AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:AUTISM, BEHAVIOR, AND PSYCHOLOGICAL SERVICES
Other - Org Name:ABPS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DYAN
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-206-8154
Mailing Address - Street 1:13115 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-4412
Mailing Address - Country:US
Mailing Address - Phone:913-206-8154
Mailing Address - Fax:913-608-5756
Practice Address - Street 1:400 SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1955
Practice Address - Country:US
Practice Address - Phone:913-206-8154
Practice Address - Fax:913-608-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1031397103K00000X
KS932103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty