Provider Demographics
NPI:1417597097
Name:MARY ARCHER, LLC
Entity type:Organization
Organization Name:MARY ARCHER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:816-387-3215
Mailing Address - Street 1:110 N CHERRY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3473
Mailing Address - Country:US
Mailing Address - Phone:816-387-3215
Mailing Address - Fax:
Practice Address - Street 1:110 N CHERRY ST STE 110
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3473
Practice Address - Country:US
Practice Address - Phone:816-387-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty