Healthcare Provider Details

I. General information

NPI: 1669097036
Provider Name (Legal Business Name): A CONSCIOUS PEACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22450 S HARRISON ST
SPRING HILL KS
66083-3151
US

IV. Provider business mailing address

917 N SUMAC ST
OLATHE KS
66061-5976
US

V. Phone/Fax

Practice location:
  • Phone: 913-353-9020
  • Fax:
Mailing address:
  • Phone: 913-353-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier4406
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerKANSAS BEHAVIORAL SCIENCE REGULATORY BOARD

VIII. Authorized Official

Name: MICHAEL J CANNADY
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 913-353-9020