Provider Demographics
NPI:1952682593
Name:OLSON, KELLY ANN CLEVENGER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN CLEVENGER
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CLEVENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E 24TH STREET
Mailing Address - Street 2:UNIT 2D
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-404-3896
Mailing Address - Fax:816-404-3881
Practice Address - Street 1:1000 E 24TH STREET
Practice Address - Street 2:UNIT 2D
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-404-3896
Practice Address - Fax:816-404-3881
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024383101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health