Provider Demographics
NPI:1700589306
Name:KANSAS WELLNESS, LLC
Entity Type:Organization
Organization Name:KANSAS WELLNESS, LLC
Other - Org Name:ELLIE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-747-4960
Mailing Address - Street 1:7500 W 160TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8100
Mailing Address - Country:US
Mailing Address - Phone:913-747-4960
Mailing Address - Fax:913-423-1230
Practice Address - Street 1:7500 W 160TH ST STE 100
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-8100
Practice Address - Country:US
Practice Address - Phone:913-747-4960
Practice Address - Fax:913-423-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty