Provider Demographics
NPI:1720742554
Name:GROVER, MICHAEL S (LMSW, LCAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:GROVER
Suffix:
Gender:M
Credentials:LMSW, LCAC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:S
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, LCAC
Mailing Address - Street 1:121 S WHITTIER RD STE 360
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1064
Mailing Address - Country:US
Mailing Address - Phone:816-866-7039
Mailing Address - Fax:316-351-6446
Practice Address - Street 1:121 S WHITTIER RD STE 360
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1064
Practice Address - Country:US
Practice Address - Phone:816-866-7039
Practice Address - Fax:316-351-6446
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS567101YA0400X
KS6823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)