=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063378974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNFLOWER MENTAL HEALTH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 S 8TH ST
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66508-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-619-6078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 S 8TH ST
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66508-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-619-6078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | CRYSTAL LEIS
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 785-619-6078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------