Provider Demographics
NPI:1871876250
Name:DALZELL, AMBER (LCPC, ATR-BC, ATCS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DALZELL
Suffix:
Gender:F
Credentials:LCPC, ATR-BC, ATCS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:DALZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8826 SANTA FE DR STE 311
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3649
Mailing Address - Country:US
Mailing Address - Phone:913-732-0622
Mailing Address - Fax:
Practice Address - Street 1:8826 SANTA FE DR STE 311
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3649
Practice Address - Country:US
Practice Address - Phone:913-732-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2024-10-17
Deactivation Date:2024-04-04
Deactivation Code:
Reactivation Date:2024-04-17
Provider Licenses
StateLicense IDTaxonomies
KS24461041C0700X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200749870CMedicaid