Provider Demographics
NPI:1922313741
Name:LOOKING GLASS THERAPY CENTER
Entity Type:Organization
Organization Name:LOOKING GLASS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:913-403-0032
Mailing Address - Street 1:4101 W 54TH TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2416
Mailing Address - Country:US
Mailing Address - Phone:913-403-0032
Mailing Address - Fax:913-403-0095
Practice Address - Street 1:4101 W 54TH TER
Practice Address - Street 2:SUITE B
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2416
Practice Address - Country:US
Practice Address - Phone:913-403-0032
Practice Address - Fax:913-403-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty