Provider Demographics
NPI:1891258695
Name:QUEEN, ROBERT L (LSCSW, LAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:QUEEN
Suffix:
Gender:M
Credentials:LSCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-4229
Mailing Address - Country:US
Mailing Address - Phone:620-421-3770
Mailing Address - Fax:620-421-0665
Practice Address - Street 1:1730 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4229
Practice Address - Country:US
Practice Address - Phone:620-421-3770
Practice Address - Fax:620-421-0665
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1630101YA0400X
KS12106104100000X
KS062121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker