Provider Demographics
NPI:1194701235
Name:WARING, SHIRLEY
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:WARING
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 1:4726 W 78TH TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4413
Mailing Address - Country:US
Mailing Address - Phone:913-710-2040
Mailing Address - Fax:913-766-1916
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1620
Practice Address - Country:US
Practice Address - Phone:913-710-2040
Practice Address - Fax:913-766-1916
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494866924Medicaid