Provider Demographics
NPI:1932756855
Name:EAGLE, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-4229
Mailing Address - Country:US
Mailing Address - Phone:620-421-3770
Mailing Address - Fax:
Practice Address - Street 1:1730 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4229
Practice Address - Country:US
Practice Address - Phone:620-421-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical