Provider Demographics
NPI:1841019411
Name:KALEIDOSCOPE PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:KALEIDOSCOPE PSYCHOTHERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:785-251-3178
Mailing Address - Street 1:800 SW JACKSON ST STE 618
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 WAKARUSA DR STE C3A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3910
Practice Address - Country:US
Practice Address - Phone:785-251-3178
Practice Address - Fax:785-201-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004646290002Medicaid