Healthcare Provider Details
I. General information
NPI: 1912683954
Provider Name (Legal Business Name): SAINT CHARBEL MENTAL HEALTH AND WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
13830 SANTA FE TRAIL DR STE 109
LENEXA KS
66215-3381
US
IV. Provider business mailing address
13830 SANTA FE TRAIL DR STE 109
LENEXA KS
66215-3381
US
V. Phone/Fax
- Phone: 913-413-3429
- Fax:
- Phone: 913-413-3429
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
LUCY
M.
GICHIRU
Title or Position: NURSE PRACTITIONER
Credential: PMHNP - BC
Phone: 913-413-3429