Provider Demographics
NPI:1700415270
Name:SIMPSON, CHRISTAL A (ABAT)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:A
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:ABAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1966
Mailing Address - Country:US
Mailing Address - Phone:913-250-5509
Mailing Address - Fax:913-250-5509
Practice Address - Street 1:403 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1966
Practice Address - Country:US
Practice Address - Phone:913-250-5509
Practice Address - Fax:913-250-5509
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician