Provider Demographics
NPI:1710292628
Name:JANSONIUS, LARA KAY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:KAY
Last Name:JANSONIUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LARA
Other - Middle Name:KAY
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:205 E 7TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4907
Mailing Address - Country:US
Mailing Address - Phone:785-543-7070
Mailing Address - Fax:785-301-2325
Practice Address - Street 1:205 E 7TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4907
Practice Address - Country:US
Practice Address - Phone:785-543-7070
Practice Address - Fax:785-301-2325
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW7770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100269200 BMedicaid