Provider Demographics
NPI:1821571738
Name:CREATING CONNECTIONS THERAPY LLC
Entity Type:Organization
Organization Name:CREATING CONNECTIONS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP, BCBA
Authorized Official - Phone:913-709-7485
Mailing Address - Street 1:12315 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1437
Mailing Address - Country:US
Mailing Address - Phone:913-709-7485
Mailing Address - Fax:
Practice Address - Street 1:12315 CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1437
Practice Address - Country:US
Practice Address - Phone:913-709-7485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty