# PRAIRIE VILLAGE BEHAVIORAL HEALTH

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

## Provider details

- **NPI number:** 1821252255
- **Authorized official:** MS. KIM WEAVER (BILLING MANAGER)
- **Authorized official phone:** (785) 266-0031

## Contact information

- **Practice address:** 26431 W 109TH TER, OLATHE, KS 66061-8779
- **Practice address phone:** (785) 266-0031
- **Practice address fax:** (785) 266-4225
- **Mailing address:** PO BOX 3905, LAWRENCE, KS 66046-0905
- **Mailing address phone:** (785) 266-0031
- **Mailing address fax:** (785) 266-4225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 0294 | KS | Yes |

## Other

- **Enumeration date:** 07/15/2008
- **Last updated:** 12/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 119010 | BCBS OF KANSAS | KS |
| 01 | — | 25212023 | BCBS OF KANSAS CITY | MO |