Provider Demographics
NPI:1104123553
Name:ALTENBERND, MARY ANN (LPC)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:ALTENBERND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 STATE LINE RD
Mailing Address - Street 2:SUITE435
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1960
Mailing Address - Country:US
Mailing Address - Phone:913-907-7911
Mailing Address - Fax:913-221-0152
Practice Address - Street 1:8900 STATE LINE RD
Practice Address - Street 2:SUITE435
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1960
Practice Address - Country:US
Practice Address - Phone:913-907-7911
Practice Address - Fax:913-221-0152
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional