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General NPI Number Information
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NPI Number | 1326723107
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Entity Type | Organization
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Legal Business Name | ELEVATED MINDS COUNSELING LLC
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 6611 E CENTRAL AVE STE C
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City | WICHITA
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State | KS
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Zip | 67206-1937
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Country | US
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Telephone | 316-706-1873
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Fax |
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Provider Business Mailing Address
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Address Line | 1824 N NEWBERRY CIR
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City | DERBY
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State | KS
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Zip | 67037-2314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB THOMAS MILLER
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Credential | LMSW
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Telephone | 316-706-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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