| Summit Ranch Llc | |
|
18555 Johnson Dr Shawnee KS 66217-8206 | |
| (913) 215-2438 | |
| (913) 424-2440 |
| Full Name | Summit Ranch Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 18555 Johnson Dr, Shawnee, Kansas |
| Authorized Official Name and Position | Adria Estes (BILLING AND CREDENTIALING MGR) |
| Authorized Official Contact | 2082690689 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Ranch Llc 18555 Johnson Dr Ste 119 Shawnee KS 66217-8206 Ph: (913) 215-2438 | Summit Ranch Llc 18555 Johnson Dr Shawnee KS 66217-8206 Ph: (913) 215-2438 |
| NPI Number | 1306561147 |
|---|---|
| Provider Enumeration Date | 10/04/2022 |
| Last Update Date | 10/04/2022 |
| Certification Date | 10/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306561147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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