Healthcare Provider Details

I. General information

NPI: 1629620679
Provider Name (Legal Business Name): HEAD TO HEART INTEGRATIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S ROGERS RD
LOUISBURG KS
66053-4064
US

IV. Provider business mailing address

7111 W 151ST ST # 179
OVERLAND PARK KS
66223-2231
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-9073
  • Fax: 913-937-4434
Mailing address:
  • Phone: 913-735-9073
  • Fax: 913-937-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MANDI SHROCK
Title or Position: OWNER
Credential: LCPC
Phone: 913-735-9073