NPIMap

Organization Active NPI

Indian Creek Psychological Services

  • Professional Counselor
  • Olathe, KS
National Provider Identifier
1265256879
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
INDIAN CREEK PSYCHOLOGICAL SERVICES
Practice address
15022 W 128TH St
Olathe, KS 66062-5809
Phone
(913) 636-5657
Fax
(913) 395-0562
NPI assigned
Nov 11, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth Lee Morris, ED.D., L.C.P.C.NPI 1528266095
Title
President
Phone
(913) 636-5657

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
In Home Supportive Care Agency 253Z00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

15022 W 128TH St
Olathe, KS 66062-5809

Mailing address

15022 W 128TH St
Olathe, KS 66062-5809
Phone (913) 636-5657

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250828001174 KS Part B Supplier - Clinic/Group Practice 8729589148 Receives reassigned benefits from 1 practitioner
Practice locations: Olathe, KS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1265256879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15022 W 128TH ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660625809",
            "telephone_number": "913-636-5657",
            "fax_number": "913-395-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15022 W 128TH ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660625809",
            "telephone_number": "913-636-5657",
            "fax_number": "913-395-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN CREEK PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "913-636-5657",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D., L.C.P.C."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.