Provider Demographics
NPI:1356707194
Name:LASATER, JUSTIN (MA, LMLP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LASATER
Suffix:
Gender:M
Credentials:MA, LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W 94TH TER
Mailing Address - Street 2:#200
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2522
Mailing Address - Country:US
Mailing Address - Phone:913-383-8100
Mailing Address - Fax:
Practice Address - Street 1:5200 W 94TH TER
Practice Address - Street 2:#200
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2522
Practice Address - Country:US
Practice Address - Phone:913-383-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2891103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist