Provider Demographics
NPI:1487114807
Name:OLIPHANT, ANITA
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:OLIPHANT
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 1:5201 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1149
Mailing Address - Country:US
Mailing Address - Phone:913-563-2541
Mailing Address - Fax:
Practice Address - Street 1:9430 GILLETTE ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-3770
Practice Address - Country:US
Practice Address - Phone:816-873-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRBT-19-81708106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSRBT-19-81708OtherRBT