Provider Demographics
NPI:1205938669
Name:CRENSHAW, WESLEY B (PHD ABPP CST)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:B
Last Name:CRENSHAW
Suffix:
Gender:M
Credentials:PHD ABPP CST
Other - Prefix:
Other - First Name:WES
Other - Middle Name:B
Other - Last Name:CRENSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD ABPP
Mailing Address - Street 1:3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:785-371-4519
Practice Address - Street 1:3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC
Practice Address - Street 2:SUITE 104
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:785-371-4519
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0894103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100353150 AMedicaid
KS119046OtherBCBS OF KS