Basic Information
| Provider Information | |||||||||
| NPI: | 1225009210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHANA | ||||||||
| FirstName: | KASTOOR | ||||||||
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| Credential: | LP PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MAINE ST | ||||||||
| Address2: | STE A | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439192 | ||||||||
| FaxNumber: | 7858436744 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MAINE ST | ||||||||
| Address2: | STE A | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439192 | ||||||||
| FaxNumber: | 7858436744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 893 | KS | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.