Healthcare Provider Details

I. General information

NPI: 1295628238
Provider Name (Legal Business Name): TICUM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 COLLEGE BLVD STE 125
OVERLAND PARK KS
66210-2034
US

IV. Provider business mailing address

8645 COLLEGE BLVD STE 125
OVERLAND PARK KS
66210-2034
US

V. Phone/Fax

Practice location:
  • Phone: 913-228-3099
  • Fax:
Mailing address:
  • Phone: 913-228-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MORGAN TICUM
Title or Position: OWNER
Credential: LCMFT
Phone: 913-228-3099