Provider Demographics
NPI:1801579545
Name:ATKIN, MARY TIFFANY (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:TIFFANY
Last Name:ATKIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 W 110TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2620
Mailing Address - Country:US
Mailing Address - Phone:913-620-7469
Mailing Address - Fax:
Practice Address - Street 1:8575 W 110TH ST STE 225
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2620
Practice Address - Country:US
Practice Address - Phone:913-620-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health