Provider Demographics
NPI:1598857641
Name:MOLLY TRAFFAS, LLC
Entity Type:Organization
Organization Name:MOLLY TRAFFAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAFFAS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-946-0990
Mailing Address - Street 1:3425 W CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4919
Mailing Address - Country:US
Mailing Address - Phone:316-946-0990
Mailing Address - Fax:316-943-1139
Practice Address - Street 1:3425 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4919
Practice Address - Country:US
Practice Address - Phone:316-946-0990
Practice Address - Fax:316-943-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100457290BMedicaid
KS180517OtherBC/BS
KSP84331Medicare UPIN
KS180517Medicare ID - Type Unspecified