Provider Demographics
NPI:1215231220
Name:TWO ROADS FAMILY THERAPY
Entity type:Organization
Organization Name:TWO ROADS FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER, MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:316-247-1133
Mailing Address - Street 1:313 N SENECA ST STE 118
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5951
Mailing Address - Country:US
Mailing Address - Phone:316-247-1133
Mailing Address - Fax:316-262-2799
Practice Address - Street 1:313 N SENECA ST STE 118
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5951
Practice Address - Country:US
Practice Address - Phone:316-247-1133
Practice Address - Fax:316-262-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty