Provider Demographics
NPI:1215672563
Name:CROWN OF POWER
Entity type:Organization
Organization Name:CROWN OF POWER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-325-7836
Mailing Address - Street 1:841 20000 RD
Mailing Address - Street 2:
Mailing Address - City:MOUND VALLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67354-9256
Mailing Address - Country:US
Mailing Address - Phone:191-832-5783
Mailing Address - Fax:
Practice Address - Street 1:841 20000 RD
Practice Address - Street 2:
Practice Address - City:MOUND VALLEY
Practice Address - State:KS
Practice Address - Zip Code:67354-9256
Practice Address - Country:US
Practice Address - Phone:191-832-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Multi-Specialty