MEDICARE: KANSAS WELLNESS, 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	:	1700589306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANSAS WELLNESS, LLC

Provider Business Mailing Address
First Line	:	7500 W 160TH ST STE 100
Second Line	:
City	:	STILWELL
State	:	KS
Zip	:	66085-8100
Country	:	US
Telephone Number	:	913-747-4960
Fax Number	:	913-423-1230

Provider Business Practice Location Address
First Line	:	7500 W 160TH ST STE 100
Second Line	:
City	:	STILWELL
State	:	KS
Zip	:	66085-8100
Country	:	US
Telephone Number	:	913-747-4960
Fax Number	:	913-423-1230

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY COLE
Credential	:
Telephone Number	:	913-747-4960

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	04/03/2024

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Directions to “KANSAS WELLNESS, LLC ” Practice Location

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