| Chris Brotherton | |
|
11937 W 119th St # 197 Overland Park KS 66213-2215 | |
| (913) 489-7224 | |
| (913) 440-0309 |
| Full Name | Chris Brotherton |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11937 W 119th St # 197, Overland Park, Kansas |
| Authorized Official Name and Position | Christopher Brotherton (OWNER) |
| Authorized Official Contact | 9134897224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chris Brotherton 11937 W 119th St Ste 197 Overland Park KS 66213-2215 Ph: () - | Chris Brotherton 11937 W 119th St # 197 Overland Park KS 66213-2215 Ph: (913) 489-7224 |
| NPI Number | 1548647506 |
|---|---|
| Provider Enumeration Date | 04/29/2015 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Medicare PECOS PAC ID | 4284078833 |
|---|---|
| Medicare Enrollment ID | O20240222000613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548647506 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | 890 (Kansas) | Primary |
| Provider Name | Christopher Brotherton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1326310863 PECOS PAC ID: 6002250651 Enrollment ID: I20240222000664 |
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