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Organization
ACCOMPLISHKC
Active
Organization
ACCOMPLISHKC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETIENNE CLATANOFF LPC, LPCP (CLINICAL CONSULTANT 1)
(913) 302-1773
Entity
Organization
Contact information
Practice address
2108 W 75TH ST STE D, PRAIRIE VILLAGE, KS 66208-3504
(913) 543-1707
Mailing address
4517 W 75TH ST, PRAIRIE VILLAGE, KS 66208-4378
(913) 302-1773
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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