Provider Demographics
NPI:1780419531
Name:KURTZ, ELISE MEGAN (T-LMFT)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MEGAN
Last Name:KURTZ
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12836 MASTIN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3493
Mailing Address - Country:US
Mailing Address - Phone:913-333-6840
Mailing Address - Fax:
Practice Address - Street 1:11020 KING ST STE 108
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1201
Practice Address - Country:US
Practice Address - Phone:913-333-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03632-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist