| Therapeutic Alliance Group | |
|
151 N Ridge Rd Ste 6 Wichita KS 67212-4400 | |
| (316) 409-0565 | |
| (855) 915-0285 |
| Full Name | Therapeutic Alliance Group |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 151 N Ridge Rd Ste 6, Wichita, Kansas |
| Authorized Official Name and Position | Ana Liza Scully-skinner (CEO) |
| Authorized Official Contact | 8084998391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Therapeutic Alliance Group 101 N Ridge Rd Ste 6 Wichita KS 67212-3367 Ph: (316) 409-0565 | Therapeutic Alliance Group 151 N Ridge Rd Ste 6 Wichita KS 67212-4400 Ph: (316) 409-0565 |
| NPI Number | 1275011462 |
|---|---|
| Provider Enumeration Date | 07/31/2018 |
| Last Update Date | 04/10/2023 |
| Certification Date | 04/10/2023 |
| Medicare PECOS PAC ID | 0547626178 |
|---|---|
| Medicare Enrollment ID | O20230523003105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275011462 | NPI | - | NPPES |
| Provider Name | Indy M Fairbanks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013267756 PECOS PAC ID: 8729355573 Enrollment ID: I20170525002063 |
| Provider Name | Meaghan Ann Mackey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992318729 PECOS PAC ID: 0345606976 Enrollment ID: I20230523003171 |
| Provider Name | Ana Liza Scully-skinner |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144701194 PECOS PAC ID: 1456717081 Enrollment ID: I20231220003561 |
| Provider Name | Ginger Golden |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1851809149 PECOS PAC ID: 1153766639 Enrollment ID: I20240224000574 |
| Provider Name | Suzanah Richelle Schoen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1396226445 PECOS PAC ID: 2365808995 Enrollment ID: I20240326000996 |
| Provider Name | Kamilah Sharpe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528544087 PECOS PAC ID: 3274999800 Enrollment ID: I20240327000654 |
| Provider Name | Alexis Brianne Miller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1750852760 PECOS PAC ID: 4183080716 Enrollment ID: I20240409001919 |
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