=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255901724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DT COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2021
-----------------------------------------------------
Last Update Date | 07/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 N ROCK RD STE 130
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-1287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-253-9686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14113 W MONTEREY ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67235-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-253-9686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MRS. DANIELLE NM THRUSH
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 316-253-9686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------