Provider Demographics
NPI:1538251194
Name:MAGILL, DAVID JAMES (LSCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:MAGILL
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S SOMERSET CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3668
Mailing Address - Country:US
Mailing Address - Phone:785-233-1165
Mailing Address - Fax:785-233-1209
Practice Address - Street 1:1125 S SOMERSET CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3668
Practice Address - Country:US
Practice Address - Phone:785-233-1165
Practice Address - Fax:785-233-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 14331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSXXXXX8503660490000OtherTRICARE
KS0000011794OtherBLUE CROSS BLUE SHIELD
KS100004310AMedicaid
KS62-80506OtherUNITED HEALTH CARE
KSXXXXX8503660490000OtherTRICARE
KS62-80506OtherUNITED HEALTH CARE