Individual
LARA M WISDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11900 W 87TH STREET PKWY STE 130, LENEXA, KS 66215-4517
(615) 571-3982
Mailing address
8818 GOLDEN LN, DE SOTO, KS 66018-7501
(615) 571-3982
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3527
KS
101YP2500X
Professional Counselor
2020037121
MO
Other
Enumeration date
03/12/2020
Last updated
04/09/2024
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