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General NPI Number Information
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NPI Number | 1528657632
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Entity Type | Organization
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Legal Business Name | CRISTIN STICE CONSULTING, LLC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 13829 GROVE AVE
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City | BONNER SPRINGS
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State | KS
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Zip | 66012-9685
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Country | US
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Telephone | 913-205-2486
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Fax |
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Provider Business Mailing Address
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Address Line | 13829 GROVE AVE
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City | BONNER SPRINGS
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State | KS
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Zip | 66012-9685
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Country | US
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Telephone | 913-205-2486
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CRISTIN L. STICE
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Credential | LSCSW
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Telephone | 913-205-2486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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