Provider Demographics
NPI:1215607346
Name:GIOCONDO, LILLIAN
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:GIOCONDO
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 1:9325 PFLUMM RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3347
Mailing Address - Country:US
Mailing Address - Phone:913-374-7800
Mailing Address - Fax:
Practice Address - Street 1:9325 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3347
Practice Address - Country:US
Practice Address - Phone:913-374-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2022-10-06
Deactivation Date:2021-10-28
Deactivation Code:
Reactivation Date:2022-10-06
Provider Licenses
StateLicense IDTaxonomies
KS03857101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional