Provider Demographics
NPI:1700389608
Name:FAN, XINLI (LMFT, LCMFT)
Entity Type:Individual
Prefix:MR
First Name:XINLI
Middle Name:
Last Name:FAN
Suffix:
Gender:M
Credentials:LMFT, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 E 128TH TER
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1923
Mailing Address - Country:US
Mailing Address - Phone:913-228-1081
Mailing Address - Fax:
Practice Address - Street 1:1535 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5849
Practice Address - Country:US
Practice Address - Phone:816-966-0900
Practice Address - Fax:816-347-3200
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03120106H00000X
MO2022011310106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist