Healthcare Provider Details

I. General information

NPI: 1639633829
Provider Name (Legal Business Name): HEALING GROUNDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N MAIN ST
MCPHERSON KS
67460-2839
US

IV. Provider business mailing address

803 N MAIN ST
MCPHERSON KS
67460-2839
US

V. Phone/Fax

Practice location:
  • Phone: 620-885-5041
  • Fax:
Mailing address:
  • Phone: 620-885-5041
  • Fax:

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 TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNA L MARFO
Title or Position: OWNER
Credential: LCMFT
Phone: 620-885-5041