Provider Demographics
NPI:1396887519
Name:HARTLEY, DEBRA JEANETTE (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEANETTE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:JEANETTE
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:8400 W 110TH
Mailing Address - Street 2:SUITE 510
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-491-3460
Mailing Address - Fax:913-491-1141
Practice Address - Street 1:8400 W 110TH
Practice Address - Street 2:SUITE 510
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-491-3460
Practice Address - Fax:913-491-1141
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS998LSCSW104100000X
MOLSCSW2005038977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100289830AMedicaid
KS0002592Medicare ID - Type Unspecified