Provider Demographics
NPI:1063895209
Name:LET'S TALK THERAPY AND SUPERVISION INC
Entity type:Organization
Organization Name:LET'S TALK THERAPY AND SUPERVISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:HOLOUBEK
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, RPT
Authorized Official - Phone:316-691-7201
Mailing Address - Street 1:2458 W NEWELL ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5108
Mailing Address - Country:US
Mailing Address - Phone:316-691-7201
Mailing Address - Fax:316-847-7082
Practice Address - Street 1:2458 W NEWELL ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5108
Practice Address - Country:US
Practice Address - Phone:316-691-7201
Practice Address - Fax:316-847-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200438180HMedicaid
S1787OtherREGISTERED PLAY THERAPIST-SUPERVISOR