Healthcare Provider Details

I. General information

NPI: 1942783535
Provider Name (Legal Business Name): SUNFLOWER PSYCHOLOGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 JOHNSON DR STE 210
MISSION KS
66205-2920
US

IV. Provider business mailing address

6701 REEDS RD
OVERLAND PARK KS
66204-1538
US

V. Phone/Fax

Practice location:
  • Phone: 913-313-2044
  • Fax:
Mailing address:
  • Phone: 913-313-2044
  • Fax: 913-229-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1902059249
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: CHERYL R GRAVES
Title or Position: OWNER
Credential: MSW, LCSW, LSCSW
Phone: 913-313-2044