NPIMap

Organization Active NPI

Family Therapy Institute Midwest

  • Clinical Child & Adolescent Psychologist
  • Lawrence, KS
National Provider Identifier
1306872064
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
0894 Issued in KS
Legal business name
FAMILY THERAPY INSTITUTE MIDWEST
Practice address
2619 W. 6TH Street, Suite C
Lawrence, KS 66049
Phone
(785) 830-8299
Fax
(785) 749-2581
NPI assigned
Jun 24, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mary Lu Egidy, APRNNPI 1841392206
Title
Owner
Phone
(785) 830-8299

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

Practitioners 12

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

National Provider Directory

National Provider Directory

Specialties & licenses 7

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X 0894 KS Primary
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X 1109 KS
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X 6890 KS
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 1740 KS
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 3569 KS
Child & Adolescent Psychiatric/Mental Health Registered NurseGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 163WP0807X 74564 KS
Child & Adolescent Psychiatric/Mental Health Registered NurseGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 163WP0807X 46111 KS

Addresses

NPPES NPI Registry

Primary practice location

2619 W. 6TH Street, Suite C
Lawrence, KS 66049

Mailing address

2619 W. 6TH Street, Suite C
Lawrence, KS 66049
Phone (785) 830-8299

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
100389740AMedicaidKS
100353150AMedicaidKS
100353230AMedicaidKS
100297790CMedicaidKS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 7, 2016.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1306872064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 W. 6TH STREET, SUITE C",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "66049",
            "telephone_number": "785-830-8299",
            "fax_number": "785-749-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 W. 6TH STREET, SUITE C",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "66049",
            "telephone_number": "785-830-8299",
            "fax_number": "785-749-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY THERAPY INSTITUTE MIDWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "EGIDY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-830-8299",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KS",
            "license": "0894",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KS",
            "license": "1109",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "KS",
            "license": "6890",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "1740",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "3569",
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "KS",
            "license": "74564",
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "KS",
            "license": "46111",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100389740A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100353150A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100353230A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100297790C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.