MEDICARE: ECLECTIC HOPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1417635590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECLECTIC HOPE

Provider Business Mailing Address
First Line	:	PO BOX 771412
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67277-1412
Country	:	US
Telephone Number	:	316-214-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	5838 W 21ST ST N STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1795
Country	:	US
Telephone Number	:	316-214-7911
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	KAILA SPRING
Credential	:	LPC
Telephone Number	:	316-214-7911

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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Directions to “ECLECTIC HOPE ” Practice Location

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