Basic Information
| Provider Information | |||||||||
| NPI: | 1679818728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANIU | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | NYAKIO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KANIU-LAKE | ||||||||
| OtherFirstName: | NYAKIO | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9250 GLENWOOD ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662121365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139526696 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9250 GLENWOOD ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662121365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139526696 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2012 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2409 | KS | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 2409 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.