Provider Demographics
NPI:1316300239
Name:TAPESTRY PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:TAPESTRY PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-275-0644
Mailing Address - Street 1:504 N KANSAS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-3346
Mailing Address - Country:US
Mailing Address - Phone:620-604-5274
Mailing Address - Fax:844-704-5822
Practice Address - Street 1:529 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-3309
Practice Address - Country:US
Practice Address - Phone:620-417-3106
Practice Address - Fax:620-624-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76030363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty