| NPI | 1992230510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY W BASE Chief Executive Officer 316-201-3125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1465) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 248) |
| 101YP2500X Counselor, Professional (Licence: KS 2740) | |
| 101YP2500X Counselor, Professional (Licence: KS 2623) | |
| 103T00000X Psychologist (Licence: KS 2609) | |
| 103T00000X Psychologist (Licence: KS 2445) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |