Organization
KIDSTLC MEDICAL SERVICS, LLC
Active
Parent organization
KIDSTLC, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIDSTLC, INC
Authorized official
GORDON DOCKING (CEO)
(913) 324-3636
Entity
Organization
Contact information
Practice address
480 S ROGERS RD, OLATHE, KS 66062-1706
(913) 324-3636
(913) 324-3894
Mailing address
480 S ROGERS RD, OLATHE, KS 66062-1706
(913) 324-3636
(913) 324-3894
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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