Provider Demographics
NPI:1780859165
Name:AMY MEEK FAMILY THERAPY GROUP LLC
Entity Type:Organization
Organization Name:AMY MEEK FAMILY THERAPY GROUP LLC
Other - Org Name:AMY MEEK
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:316-788-6464
Mailing Address - Street 1:1525 N BUCKNER ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2948
Mailing Address - Country:US
Mailing Address - Phone:316-788-6464
Mailing Address - Fax:316-680-8267
Practice Address - Street 1:1525 N BUCKNER ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2948
Practice Address - Country:US
Practice Address - Phone:316-788-6464
Practice Address - Fax:316-680-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200429330AMedicaid