Provider Demographics
NPI:1962055616
Name:SMITH, TANISE (LPC)
Entity type:Individual
Prefix:
First Name:TANISE
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 LICHTENAUER DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1636
Mailing Address - Country:US
Mailing Address - Phone:913-549-6918
Mailing Address - Fax:816-974-3389
Practice Address - Street 1:8220 LICHTENAUER DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1636
Practice Address - Country:US
Practice Address - Phone:913-549-6918
Practice Address - Fax:816-974-3389
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230499211041C0700X
KS033281041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical