=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487558938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCHETYPE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 NE 46TH ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64117-1229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-543-8870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3701 NE 46TH ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64117-1229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-543-8870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DIANNA CHRISTINE OBERMUELLER
-----------------------------------------------------
Credential | LCSW, LSCSW
-----------------------------------------------------
Telephone | 214-543-8870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------