Provider Demographics
NPI:1366004004
Name:MINDFUL THERAPY KC, LLC
Entity Type:Organization
Organization Name:MINDFUL THERAPY KC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN-MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:913-738-7922
Mailing Address - Street 1:6801 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2005
Mailing Address - Country:US
Mailing Address - Phone:913-738-7922
Mailing Address - Fax:
Practice Address - Street 1:6711 W 121ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2003
Practice Address - Country:US
Practice Address - Phone:913-738-7922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3756OtherBSRB LICENSE