# ACCOMPLISHKC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255815874
- **Authorized official:** ETIENNE CLATANOFF LPC, LPCP (CLINICAL CONSULTANT 1)
- **Authorized official phone:** (913) 302-1773

## Contact information

- **Practice address:** 2108 W 75TH ST STE D, PRAIRIE VILLAGE, KS 66208-3504
- **Practice address phone:** (913) 543-1707
- **Mailing address:** 4517 W 75TH ST, PRAIRIE VILLAGE, KS 66208-4378
- **Mailing address phone:** (913) 302-1773

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 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