Healthcare Provider Details

I. General information

NPI: 1043712912
Provider Name (Legal Business Name): CREATIVE BLISS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 E 2ND ST N STE 100
WICHITA KS
67214-4129
US

IV. Provider business mailing address

1646 E 2ND ST N STE 100
WICHITA KS
67214-4129
US

V. Phone/Fax

Practice location:
  • Phone: 316-395-1030
  • Fax: 316-330-6622
Mailing address:
  • Phone: 316-395-1030
  • Fax: 316-330-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3032
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4549
License Number StateKS

VIII. Authorized Official

Name: KATHERINE FRANCIS
Title or Position: PARTNER/THERAPIST
Credential: LCPC
Phone: 316-395-1030