Provider Demographics
NPI:1780079103
Name:INTENTIONAL CHALLENGE, LLC
Entity type:Organization
Organization Name:INTENTIONAL CHALLENGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VIGNERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:913-568-8276
Mailing Address - Street 1:11100 ASH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1925
Mailing Address - Country:US
Mailing Address - Phone:913-568-8276
Mailing Address - Fax:913-696-1403
Practice Address - Street 1:11100 ASH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1925
Practice Address - Country:US
Practice Address - Phone:913-568-8276
Practice Address - Fax:913-696-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty