Healthcare Provider Details

I. General information

NPI: 1992432389
Provider Name (Legal Business Name): WINGS OF HARMONY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 HIGHLY ST
SAINT JOSEPH MO
64506-2634
US

IV. Provider business mailing address

3414 SCOTT ST
SAINT JOSEPH MO
64507-1958
US

V. Phone/Fax

Practice location:
  • Phone: 816-248-9257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN MARQUEZ
Title or Position: LPC CEO/FOUNDER
Credential:
Phone: 816-248-9257