Provider Demographics
NPI:1306357645
Name:ENSO THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:ENSO THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:913-220-2450
Mailing Address - Street 1:9200 INDIAN CREEK PKWY STE 660
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2097
Mailing Address - Country:US
Mailing Address - Phone:913-220-2450
Mailing Address - Fax:913-220-2423
Practice Address - Street 1:9200 INDIAN CREEK PKWY STE 660
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2097
Practice Address - Country:US
Practice Address - Phone:913-220-2450
Practice Address - Fax:913-220-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TC1900X
KS103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty