Healthcare Provider Details

I. General information

NPI: 1730585639
Provider Name (Legal Business Name): REPAIR AND REBUILD COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 STRANG LINE RD
LENEXA KS
66215-4040
US

IV. Provider business mailing address

11261 STRANG LINE RD
LENEXA KS
66215-4040
US

V. Phone/Fax

Practice location:
  • Phone: 913-401-5318
  • Fax:
Mailing address:
  • Phone: 913-401-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2671
License Number StateKS

VIII. Authorized Official

Name: ASHTON N LEAMING
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: M.A., L.P.C., N.C.C.
Phone: 913-401-5318