Provider Demographics
NPI:1538650783
Name:CANEY FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:CANEY FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:620-515-1907
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-0103
Mailing Address - Country:US
Mailing Address - Phone:620-515-1907
Mailing Address - Fax:620-222-9316
Practice Address - Street 1:107 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1301
Practice Address - Country:US
Practice Address - Phone:620-515-1907
Practice Address - Fax:620-222-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201085500AMedicaid