Healthcare Provider Details

I. General information

NPI: 1295597771
Provider Name (Legal Business Name): SEASONS OF CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 KING ST STE 222
OVERLAND PARK KS
66210-1246
US

IV. Provider business mailing address

9203 W 140TH TER
OVERLAND PARK KS
66221-2025
US

V. Phone/Fax

Practice location:
  • Phone: 913-748-1566
  • Fax:
Mailing address:
  • Phone: 913-748-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINDY HAGER
Title or Position: OWNER
Credential:
Phone: 913-748-1566