Provider Demographics
NPI:1942560248
Name:CUNNINGHAM, MITCHELENE JOELLEN (LMSW,LAC)
Entity Type:Individual
Prefix:MRS
First Name:MITCHELENE
Middle Name:JOELLEN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMSW,LAC
Other - Prefix:MRS
Other - First Name:MITCHELENE
Other - Middle Name:JOELLEN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW,LAC
Mailing Address - Street 1:6000 LAMAR AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3234
Mailing Address - Country:US
Mailing Address - Phone:913-782-0283
Mailing Address - Fax:
Practice Address - Street 1:301 N MONROE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3162
Practice Address - Country:US
Practice Address - Phone:913-782-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7824104100000X
KS773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)