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General NPI Number Information
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NPI Number | 1275966848
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Entity Type | Organization
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Legal Business Name | BROOKHOLLOW FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 08/18/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 250 N ROCK RD 130
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City | WICHITA
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State | KS
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Zip | 67206-2203
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Country | US
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Telephone | 316-804-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 8220 E BROOKHOLLOW ST
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City | WICHITA
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State | KS
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Zip | 67206-2306
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Country | US
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Telephone | 316-737-7504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAULA L SCHAEFER
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Credential | LMFT-T
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Telephone | 316-737-7504
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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 | 2480
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License Number State | KS
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