Provider Demographics
NPI:1265780142
Name:OVERLAND PARK WELLNESS, L.L.C.
Entity type:Organization
Organization Name:OVERLAND PARK WELLNESS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-515-2441
Mailing Address - Street 1:7011 W 121ST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2009
Mailing Address - Country:US
Mailing Address - Phone:913-515-2441
Mailing Address - Fax:
Practice Address - Street 1:7011 W 121ST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2009
Practice Address - Country:US
Practice Address - Phone:913-515-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-338612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty