BOULEVARD PSYCHOLOGY, LLC (NPI# 1508085291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508085291 |
| Entity Type | Organization |
| Organization Name | BOULEVARD PSYCHOLOGY, LLC |
| Practice Address |
8575 W 110th St #302 Overland Park KS 66210-1865 |
| Practice Telephone | 9134994302 |
| Practice Fax Number | 9134994304 |
| Mailing Telephone | 9134994302 |
| Mailing Fax Number | 9134994304 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. WENDY SUSAN EAVES (MANAGING MEMBER) |
| Authorized Official Telephone | 9134994302 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
KS 811 | KS | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | BLUE CROSS BLUE SHIELD | 19320048 | 01 |
| Street Address |
8575 W 110TH ST #302 |
| City | OVERLAND PARK |
| State | KS |
| Zip Code | 66210-1865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710971114 | Larry William Tyndall | Psychologist | 8575 W 110th St, Suite 302, Overland Park, KS 66210-1865 | 2005-08-31 |
| 1700325453 | Samuel Deutch | Counselor | 8575 W 110th St, Suite 324, Overland Park, KS 66210-1868 | 2017-02-14 |
| 1043699853 | Kathryn N Stanley Dds Chartered | Clinic/Center | 8575 W 110th St, Suite 110, Overland Park, KS 66210-1868 | 2015-05-26 |
| 1033517446 | Adam Joseph Clement | Marriage & Family Therapist | 8575 W 110th St, Suite 218, Overland Park, KS 66210-1868 | 2014-12-17 |
| 1306253463 | Brenda M Shriner | Counselor | 8575 W 110th St, Suite 302, Overland Park, KS 66210-1868 | 2014-07-21 |
| 1407179666 | Andrea Jett Dermyer | Marriage & Family Therapist | 8575 W 110th St, 304, Overland Park, KS 66210-1868 | 2010-03-02 |
| 1710219027 | Diane K Schmidt | Social Worker | 8575 W 110th St, Suite 304, Overland Park, KS 66210-1868 | 2010-02-11 |
| 1225278377 | Midwest Anxiety Treatment Center | Community/Behavioral Health | 8575 W 110th St, Suite 302, Overland Park, KS 66210-1868 | 2009-03-03 |
| 1740459940 | Suzanne D Heffner | Marriage & Family Therapist | 8575 W 110th St, Suite 304, Overland Park, KS 66210-1865 | 2008-02-21 |
| 1285839316 | Neal Barton Deutch | Psychologist | 8575 W 110th St, Suite 326, Overland Park, KS 66210-1865 | 2007-06-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437794302 | Sme Kansas P.a. | General Practice | 7300 West 110th Street, Commerce Plaza 1 7th Floor, Overland Park, KS 66210 | 2019-11-14 |
| 1417591165 | Refractive Cataract Center, LLC | Clinic/Center | 8300 College Boulevard, Suite 201, Overland Park, KS 66210 | 2019-11-05 |
| 1336705730 | Above & Beyond In-home Kansas, LLC | In Home Supportive Care | 7300 W. 110th Street, Suite 700, Overland Park, KS 66210 | 2019-05-13 |
| 1528531720 | Sarah J Sievers | Acupuncturist | 4800 W. 135th St. Suite 200, Leawood, Ks 66224, KS 66210 | 2019-01-10 |
| 1790286326 | Sarah E Hamilton | Physician Assistant | 8490 College Boulevard, Overland, KS 66210 | 2018-02-28 |
| 1730600750 | True Health and Wellness, LLC | Family Medicine | 11879 W. 112th Street, Suite 100, Overland Park, KS 66210 | 2017-06-29 |
| 1639610603 | Kayla Jolene Lawrance | Advanced Practice Midwife | 9202 W. 110th St., Building 36, Overland Park, KS 66210 | 2017-03-10 |
| 1972041952 | Ccrc of Cedar Rapids, LLC | Skilled Nursing Facility | 11827 W 112th St, Suite 103, Overland Park, KS 66210 | 2017-02-09 |
| 1396122008 | Laurie Jean Sansom | Counselor | 8575 W. 110th, Ste. 218, Overland Park, KS 66210 | 2015-05-01 |
| 1790181063 | Susan J. Anderson, Psy.d., Pa | Psychologist | 8500 W. 100th Street, 540, Overland Park, KS 66210 | 2014-11-13 |
| Find all providers in zip 66210 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164507547 | Dennis Richard Schemmel | Psychologist | 11018 W 126th Ter, Overland Park, KS 66213-2152 | 2006-10-26 |
| 1629015540 | Daniel Carter Claiborn | Psychologist | 10801 W 87th St, Suite 300, Overland Park, KS 66214-1657 | 2006-05-31 |
| 1831181601 | Daniel Richards Somberg | Psychologist | 8400 W 110th St, Suite 510, Overland Park, KS 66210-2302 | 2005-08-18 |
| 1528295193 | Charlotte Marie Mccloskey | Psychologist | 7501 College Blvd, Suite 250 Responsive Centers, Overland Park, KS 66210-1944 | 2009-06-22 |
| 1588743538 | Phil Elliott Alexander | Psychologist | 7501 College Blvd., Suite 250, Overland Park, KS 66210-1944 | 2006-11-02 |
| 1770596892 | Wendy S. Eaves | Psychologist | 8575 W 110th St, Suite 302, Overland Park, KS 66210-1865 | 2006-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841816253 | Katherine C Jorgenson | Psychologist | 722 S Broadway St, Leavenworth, KS 66048-2530 | 2020-06-22 |
| 1881258507 | Chassidy Lee Bryan | Psychologist | 2518 Ridge Ct Ste 103, Lawrence, KS 66046-4089 | 2019-04-29 |
| 1255823001 | Tara Jarrett | Psychologist | 2200 Sw Gage Blvd., Topeka, KS 66622 | 2018-06-06 |
| 1164928925 | Sarah M Rogers | Psychologist | 6606 W Central Ave, Wichita, KS 67212-3315 | 2018-04-02 |
| 1063803971 | Sarah A. Christensen, Phd, LLC | Psychologist | 4601 College Blvd Ste 275, Leawood, KS 66211-1678 | 2015-02-13 |
| 1700204930 | Robert Pedroza | Psychologist | 5100 Quivira Rd, Shawnee, KS 66216-1349 | 2014-04-04 |
| 1356685283 | Darwin L Eads | Psychologist | 1508 N Ridgehurst St, Wichita, KS 67230-7259 | 2012-11-15 |
| 1003192881 | Ashley Heintzelman Wiedenmeyer | Psychologist | 7507 Sagamore Rd, Prairie Village, KS 66208-3613 | 2011-10-25 |
| 1114231651 | Timothy John White | Psychologist | 532 Meadowlark Ln, Newton, KS 67114-5602 | 2010-07-26 |
| 1538308085 | Michael Lynch Maestas | Psychologist | 1200 Schwegler Drive, Room 2100, Counseling and Psychological Services, Lawrence, KS 66045-7559 | 2009-02-06 |
| Find all providers with the same taxonomy | ||||
| City | OVERLAND PARK |
| Zip Code | 66210 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.