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General NPI Number Information
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NPI Number | 1699637462
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Entity Type | Organization
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Legal Business Name | PRAIRIE ROOTS COUNSELING, LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3620 MEADOW LN
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City | WICHITA
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State | KS
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Zip | 67218-4028
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Country | US
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Telephone | 316-282-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 MEADOW LN
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City | WICHITA
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State | KS
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Zip | 67218-4028
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Country | US
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Telephone | 316-282-5787
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Fax |
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Authorized Official
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Title or Position | OWNER / MANAGING MEMBER
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Name | KRISTEN ANN PELTZER
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Credential | LMSW, THERAPIST
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Telephone | 316-282-5787
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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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