Healthcare Provider Details

I. General information

NPI: 1467124057
Provider Name (Legal Business Name): SOARING ONWARD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W SPRUCE ST
JUNCTION CITY KS
66441-3441
US

IV. Provider business mailing address

733 W SPRUCE ST
JUNCTION CITY KS
66441-3441
US

V. Phone/Fax

Practice location:
  • Phone: 912-271-6196
  • Fax:
Mailing address:
  • Phone: 912-271-6196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA BETH GUNIA-BARI
Title or Position: BCBA
Credential: BCBA, LBA
Phone: 912-271-6196