MEDICARE: BRAIN AND BODY PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1689548406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN AND BODY PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	800 E 1ST ST STE 240
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67202-2740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E 1ST ST STE 240
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67202-2740
Country	:	US
Telephone Number	:	316-260-6889
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	KRISTIN ROSE
Credential	:	LCMFT
Telephone Number	:	316-285-0268

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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