Healthcare Provider Details

I. General information

NPI: 1508362229
Provider Name (Legal Business Name): PRAIRIE FIRE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 W 135TH ST STE 200
OVERLAND PARK KS
66223-4849
US

IV. Provider business mailing address

6240 W 135TH ST STE 200
OVERLAND PARK KS
66223-4849
US

V. Phone/Fax

Practice location:
  • Phone: 816-588-1704
  • Fax: 816-817-0834
Mailing address:
  • Phone: 816-588-1704
  • Fax: 816-817-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2232
License Number StateKS

VIII. Authorized Official

Name: LEAH B MATHESON
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: NCMHC, NCC, LCPC
Phone: 913-522-0961