Provider Demographics
NPI:1063873206
Name:VROOM, BETHANY (LCPC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:VROOM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3097
Mailing Address - Country:US
Mailing Address - Phone:816-651-0997
Mailing Address - Fax:
Practice Address - Street 1:6310 LAMAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66202-4284
Practice Address - Country:US
Practice Address - Phone:816-288-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016657101YP2500X
KSLCPC1041C0700X
KS26181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional