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General NPI Number Information
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NPI Number | 1720596240
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Entity Type | Organization
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Legal Business Name | SUNHEART HOLISTIC, LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 200 N BROADWAY AVE STE 535
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City | WICHITA
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State | KS
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Zip | 67202
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Country | US
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Telephone | 316-282-4985
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N BROADWAY AVE STE 535
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City | WICHITA
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State | KS
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Zip | 67202-2301
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Country | US
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Telephone | 316-282-4985
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | TERESA O'BRIEN
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Credential | LSCSW, LSCW-R
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Telephone | 316-282-4985
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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 | R076120-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4750
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License Number State | KS
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