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General NPI Number Information
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NPI Number | 1043768286
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Entity Type | Organization
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Legal Business Name | ZOE CENTER, LLC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 215 E MADISON AVE
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City | DERBY
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State | KS
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Zip | 67037-1711
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Country | US
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Telephone | 316-530-2963
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Fax |
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Provider Business Mailing Address
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Address Line | 215 E MADISON AVE
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City | DERBY
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State | KS
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Zip | 67037-1711
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Country | US
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Telephone | 316-530-2963
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REBECCA A LIKIARDOPOULOS
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Credential |
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Telephone | 316-990-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2633
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License Number State | KS
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