Provider Demographics
NPI:1679188643
Name:IGLESIAS, JOHN (T-LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2209
Mailing Address - Country:US
Mailing Address - Phone:785-527-8271
Mailing Address - Fax:785-527-8317
Practice Address - Street 1:1115 WESTPORT DR STE D2
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2880
Practice Address - Country:US
Practice Address - Phone:785-560-3101
Practice Address - Fax:785-527-8317
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist