Provider Demographics
NPI:1255815874
Name:ACCOMPLISHKC
Entity type:Organization
Organization Name:ACCOMPLISHKC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CONSULTANT 1
Authorized Official - Prefix:
Authorized Official - First Name:ETIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLATANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPCP
Authorized Official - Phone:913-302-1773
Mailing Address - Street 1:4517 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4378
Mailing Address - Country:US
Mailing Address - Phone:913-302-1773
Mailing Address - Fax:
Practice Address - Street 1:2108 W 75TH ST STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3504
Practice Address - Country:US
Practice Address - Phone:913-543-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty