Provider Demographics
NPI:1649408865
Name:HODGES, STACEY L (LCMFT)
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6000 LAMAR AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3234
Mailing Address - Country:US
Mailing Address - Phone:913-831-2550
Mailing Address - Fax:913-826-1608
Practice Address - Street 1:1125 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3123
Practice Address - Country:US
Practice Address - Phone:913-715-7700
Practice Address - Fax:913-782-1186
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist