Provider Demographics
NPI:1982141420
Name:SOUTHARD, JASON (LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SOUTHARD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 REEDS RD
Mailing Address - Street 2:APT # 103
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3439
Mailing Address - Country:US
Mailing Address - Phone:620-875-3906
Mailing Address - Fax:816-508-3535
Practice Address - Street 1:8000 W 127TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2714
Practice Address - Country:US
Practice Address - Phone:913-951-4300
Practice Address - Fax:913-951-4321
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker