Basic Information
| Provider Information | |||||||||
| NPI: | 1275266538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRAIRIE WELLNESS COUNSELING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105C W WALL ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169747378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 W 110TH ST STE 730 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662102332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169747378 | ||||||||
| FaxNumber: | 8168171619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2022 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | HISER | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | HEATHER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8162252024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC, LCPC, CMHC, NCC | ||||||||
| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.