Healthcare Provider Details

I. General information

NPI: 1306337027
Provider Name (Legal Business Name): BLAKE BUHRMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W RANDALL ST
HESSTON KS
67062-9157
US

IV. Provider business mailing address

414 ROSEWOOD DR
HESSTON KS
67062-9186
US

V. Phone/Fax

Practice location:
  • Phone: 620-869-9986
  • Fax:
Mailing address:
  • Phone: 720-384-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2792
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: