Provider Demographics
NPI:1609088319
Name:RESOLUTIONS INDIVIDUAL, COUPLE AND FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:RESOLUTIONS INDIVIDUAL, COUPLE AND FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:316-721-8118
Mailing Address - Street 1:982 N TYLER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3271
Mailing Address - Country:US
Mailing Address - Phone:316-721-8118
Mailing Address - Fax:316-721-8139
Practice Address - Street 1:982 N TYLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3271
Practice Address - Country:US
Practice Address - Phone:316-721-8118
Practice Address - Fax:316-721-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty