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General NPI Number Information
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NPI Number | 1881085470
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Entity Type | Organization
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Legal Business Name | EPIPHANY COUNSELING CENTRE
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 1047 S PINE ST
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City | OTTAWA
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State | KS
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Zip | 66067-3242
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Country | US
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Telephone | 785-242-0500
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Fax | 785-242-7922
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Provider Business Mailing Address
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Address Line | 1047 S PINE ST
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City | OTTAWA
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State | KS
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Zip | 66067-3242
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Country | US
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Telephone | 785-242-0500
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Fax | 785-242-7922
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. DIANE MUNRO-SEYMOUR
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Credential | LSCSW
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Telephone | 785-242-0500
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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 | 104160700X
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License Number State | KS
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