Healthcare Provider Details

I. General information

NPI: 1235551227
Provider Name (Legal Business Name): HHR THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SE 1 AVE
GREAT BEND KS
67530-9696
US

IV. Provider business mailing address

5634 EISENHOWER AVE
GREAT BEND KS
67530-6324
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5173
  • Fax:
Mailing address:
  • Phone: 620-786-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number753
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number244
License Number StateKS

VIII. Authorized Official

Name: MRS. KELLEY JOHNSON
Title or Position: THERAPIST/PARTNER
Credential: LPC
Phone: 620-786-0311