Provider Demographics
NPI:1821679846
Name:PIVOVAR, ELAINA SUSAN
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:SUSAN
Last Name:PIVOVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 SPOOK ROCK WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6888
Mailing Address - Country:US
Mailing Address - Phone:913-544-6297
Mailing Address - Fax:
Practice Address - Street 1:11111 NALL AVE STE 102
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1622
Practice Address - Country:US
Practice Address - Phone:913-295-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03255-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist