Provider Demographics
NPI:1295232015
Name:CONNECTION THERAPY, LLC
Entity type:Organization
Organization Name:CONNECTION THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURROW
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:303-507-3131
Mailing Address - Street 1:309 HAPPY HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:KS
Mailing Address - Zip Code:66544-8633
Mailing Address - Country:US
Mailing Address - Phone:303-507-3131
Mailing Address - Fax:
Practice Address - Street 1:309 HAPPY HOLLOW ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:KS
Practice Address - Zip Code:66544-8633
Practice Address - Country:US
Practice Address - Phone:303-507-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201129860AMedicaid