Provider Demographics
NPI:1972928752
Name:AYCOCK, MANDY (LPC)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2317 N 86TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-2059
Mailing Address - Country:US
Mailing Address - Phone:913-638-1246
Mailing Address - Fax:
Practice Address - Street 1:2317 N 86TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-2059
Practice Address - Country:US
Practice Address - Phone:913-638-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional