Provider Demographics
NPI:1083972632
Name:COLEAN, CYNTHIA KAY (LCPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:KAY
Last Name:COLEAN
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 1:2804 W 120TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:541-530-3757
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:10551 BARKLEY ST SUITE 108
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:541-530-3757
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORC2902101YP2500X
KSLCPC03524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646733Medicaid