Provider Demographics
NPI:1801160932
Name:COSTABILE, CHERYL ANN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:COSTABILE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E EDISTO DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-7880
Mailing Address - Country:US
Mailing Address - Phone:816-322-4155
Mailing Address - Fax:
Practice Address - Street 1:8000 W 127TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213
Practice Address - Country:US
Practice Address - Phone:913-951-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012003444101YM0800X
KS2340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health