Healthcare Provider Details

I. General information

NPI: 1619890282
Provider Name (Legal Business Name): LIONS BREATH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 NE 20 AVE
GREAT BEND KS
67530-9274
US

IV. Provider business mailing address

460 NE 20 AVE
GREAT BEND KS
67530-9274
US

V. Phone/Fax

Practice location:
  • Phone: 620-804-1352
  • Fax:
Mailing address:
  • Phone: 620-804-1352
  • 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: KRYSTEN WATKINS
Title or Position: CEO
Credential: LSCSW
Phone: 620-804-1352