Healthcare Provider Details

I. General information

NPI: 1356067656
Provider Name (Legal Business Name): COUNSELING & THERAPY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 NE 46TH ST
TOPEKA KS
66617-3910
US

IV. Provider business mailing address

2040 NE 46TH ST
TOPEKA KS
66617-3910
US

V. Phone/Fax

Practice location:
  • Phone: 785-224-0383
  • Fax:
Mailing address:
  • Phone: 785-224-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WADE WALTMAN
Title or Position: OWNER
Credential: LAC
Phone: 785-224-0383