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General NPI Number Information
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NPI Number | 1992403711
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Entity Type | Organization
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Legal Business Name | CHURCH THERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 3112 W GRAND ST
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City | SPRINGFIELD
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State | MO
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Zip | 65802-5201
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Country | US
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Telephone | 781-367-2383
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Fax |
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Provider Business Mailing Address
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Address Line | 4223 E STATE HIGHWAY AA
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City | SPRINGFIELD
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State | MO
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Zip | 65803-5772
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Country | US
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Telephone | 781-367-2383
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, LPC
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Name | KRISTEN KANSIEWICZ
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Credential | PHD, LPC
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Telephone | 781-367-2383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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