Healthcare Provider Details

I. General information

NPI: 1639099732
Provider Name (Legal Business Name): OLUAE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E OSAGE RD STE 100
DERBY KS
67037-2198
US

IV. Provider business mailing address

4009 BROOKS AVE
WICHITA KS
67220-2522
US

V. Phone/Fax

Practice location:
  • Phone: 316-806-3204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANGEL B WARRIOR
Title or Position: OWNER
Credential:
Phone: 316-806-3204