Provider Demographics
NPI:1679638217
Name:BEAN, BRUCE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:BEAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 KING ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1267
Mailing Address - Country:US
Mailing Address - Phone:913-381-1830
Mailing Address - Fax:913-381-1830
Practice Address - Street 1:4200 SOMERSET DR
Practice Address - Street 2:SUITE 254
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5217
Practice Address - Country:US
Practice Address - Phone:913-381-1830
Practice Address - Fax:913-381-1830
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0401103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0006682AMedicare ID - Type UnspecifiedPSYCHOLOGIST MEDICARE