Provider Demographics
NPI:1578040721
Name:LITTLE STARS THERAPY SERVICES
Entity Type:Organization
Organization Name:LITTLE STARS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMLP
Authorized Official - Phone:785-534-9808
Mailing Address - Street 1:709 BROOKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:COLWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67030-9683
Mailing Address - Country:US
Mailing Address - Phone:785-534-9808
Mailing Address - Fax:
Practice Address - Street 1:709 BROOKSIDE PL
Practice Address - Street 2:
Practice Address - City:COLWICH
Practice Address - State:KS
Practice Address - Zip Code:67030-9683
Practice Address - Country:US
Practice Address - Phone:785-534-9808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP1199251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1275794711Medicaid