Healthcare Provider Details

I. General information

NPI: 1306017082
Provider Name (Legal Business Name): AMBER GIRON TLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S ROGERS RD
OLATHE KS
66062-1706
US

IV. Provider business mailing address

480 S ROGERS RD
OLATHE KS
66062-1706
US

V. Phone/Fax

Practice location:
  • Phone: 913-324-3829
  • Fax:
Mailing address:
  • Phone: 913-324-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number904
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: