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General NPI Number Information
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NPI Number | 1235551227
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Entity Type | Organization
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Legal Business Name | HHR THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 155 SE 1 AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-9696
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Country | US
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Telephone | 620-792-5173
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Fax |
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Provider Business Mailing Address
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Address Line | 5634 EISENHOWER AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-6324
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Country | US
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Telephone | 620-786-0311
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Fax |
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Authorized Official
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Title or Position | THERAPIST/PARTNER
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Name | MRS. KELLEY JOHNSON
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Credential | LPC
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Telephone | 620-786-0311
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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 | 244
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 753
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License Number State | KS
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