Provider Demographics
NPI:1811289705
Name:LEATHERWOOD, KARI MICHELE (LPC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:MICHELE
Last Name:LEATHERWOOD
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 1:6822 GRANADA LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1633
Mailing Address - Country:US
Mailing Address - Phone:913-722-6978
Mailing Address - Fax:
Practice Address - Street 1:2 E 59TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2116
Practice Address - Country:US
Practice Address - Phone:816-363-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010039629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional