Healthcare Provider Details

I. General information

NPI: 1811640063
Provider Name (Legal Business Name): COUNSELING AVENUES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E MADISON AVE STE 207
DERBY KS
67037-1736
US

IV. Provider business mailing address

2800 N FOREST PARK ST
DERBY KS
67037-7912
US

V. Phone/Fax

Practice location:
  • Phone: 316-206-3111
  • Fax: 316-252-1336
Mailing address:
  • Phone: 316-250-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RICHELLE STROUP
Title or Position: OWNER/THERAPIST
Credential:
Phone: 316-250-0970