Provider Demographics
NPI:1164086070
Name:CREATING CONNECTIONS THERAPY LLC
Entity Type:Organization
Organization Name:CREATING CONNECTIONS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:913-735-3393
Mailing Address - Street 1:3965 W 83RD ST # 157
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5308
Mailing Address - Country:US
Mailing Address - Phone:913-735-3393
Mailing Address - Fax:913-828-6898
Practice Address - Street 1:9100 MISSION RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1714
Practice Address - Country:US
Practice Address - Phone:913-735-3393
Practice Address - Fax:913-828-6898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATING CONNECTIONS THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821571728OtherADDITIONAL GROUP NPI NUMBER