Provider Demographics
NPI:1558865782
Name:SUNFLOWER COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:SUNFLOWER COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INSOON
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT-S, LMFT, CCPT
Authorized Official - Phone:913-683-5028
Mailing Address - Street 1:33825 199TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:KS
Mailing Address - Zip Code:66020-7305
Mailing Address - Country:US
Mailing Address - Phone:913-683-5028
Mailing Address - Fax:
Practice Address - Street 1:205 S 5TH ST STE 15
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-683-5028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS908106H00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
627094OtherTRICARE-WEST