1275266538 NPI number — PRAIRIE WELLNESS COUNSELING CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275266538 NPI number — PRAIRIE WELLNESS COUNSELING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAIRIE WELLNESS COUNSELING CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275266538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105C W WALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISONVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64701-2355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-974-7378
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 W 110TH ST STE 730
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-974-7378
Provider Business Practice Location Address Fax Number:
816-817-1619
Provider Enumeration Date:
07/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HISER
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
HEATHER
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
816-225-2024

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com