Provider Demographics
NPI:1225788029
Name:THE WICHITA THERAPY NOOK, LLC
Entity Type:Organization
Organization Name:THE WICHITA THERAPY NOOK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT-T
Authorized Official - Phone:316-469-6206
Mailing Address - Street 1:250 N ROCK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2261
Mailing Address - Country:US
Mailing Address - Phone:316-469-6206
Mailing Address - Fax:
Practice Address - Street 1:250 N ROCK RD STE 130
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2261
Practice Address - Country:US
Practice Address - Phone:316-469-6206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty