Provider Demographics
NPI:1588320295
Name:CUNNINGHAM, BRANDON MARK (LCSW, LSCSW, CRADC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:MARK
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LCSW, LSCSW, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19114
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66285-9114
Mailing Address - Country:US
Mailing Address - Phone:913-523-6081
Mailing Address - Fax:913-392-7199
Practice Address - Street 1:1707 E CEDAR ST STE 103
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1886
Practice Address - Country:US
Practice Address - Phone:620-262-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210364861041C0700X
KS055841041C0700X
MO11808101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty