Healthcare Provider Details

I. General information

NPI: 1992230510
Provider Name (Legal Business Name): SUNFLOWER PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E WILLIAM ST STE 535
WICHITA KS
67202-4015
US

IV. Provider business mailing address

209 E WILLIAM ST STE 535
WICHITA KS
67202-4015
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-3125
  • Fax:
Mailing address:
  • Phone: 316-201-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2740
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2623
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2609
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2445
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1465
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number248
License Number StateKS

VIII. Authorized Official

Name: BRADLEY W BASE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCP
Phone: 316-201-3125