Provider Demographics
NPI:1487986667
Name:MICHELE CRAFT THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:MICHELE CRAFT THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LCSW
Authorized Official - Phone:816-260-6607
Mailing Address - Street 1:10100 W 87TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4628
Mailing Address - Country:US
Mailing Address - Phone:816-260-6607
Mailing Address - Fax:
Practice Address - Street 1:10100 W 87TH ST STE 207
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4628
Practice Address - Country:US
Practice Address - Phone:816-260-6607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200428130DMedicaid
KS200428130AMedicaid
KSKA 1368Medicare PIN
KSKA1733Medicare PIN