Provider Demographics
NPI:1538721162
Name:FRACZAK, DOROTA (LPC)
Entity type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:FRACZAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:ZAJAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:
Practice Address - Street 1:1423 N JEFFERSON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2025-03-14
Deactivation Date:2019-08-13
Deactivation Code:
Reactivation Date:2020-02-28
Provider Licenses
StateLicense IDTaxonomies
MO2016033546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional