Provider Demographics
NPI:1184164543
Name:SUSAN CLAVETTE INTEGRATIVE PSYCHIATRIC NP LLC
Entity type:Organization
Organization Name:SUSAN CLAVETTE INTEGRATIVE PSYCHIATRIC NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CLAVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:913-210-6005
Mailing Address - Street 1:7171 W 95TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2249
Mailing Address - Country:US
Mailing Address - Phone:913-210-6005
Mailing Address - Fax:913-210-6008
Practice Address - Street 1:7171 W 95TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2249
Practice Address - Country:US
Practice Address - Phone:913-210-6005
Practice Address - Fax:913-210-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376322011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty