Provider Demographics
NPI:1396305835
Name:GOLDFINCH THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:GOLDFINCH THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KASPER-DOGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-619-7604
Mailing Address - Street 1:100 S MARKET ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3824
Mailing Address - Country:US
Mailing Address - Phone:316-361-0662
Mailing Address - Fax:844-766-7540
Practice Address - Street 1:100 S MARKET ST STE 2A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202
Practice Address - Country:US
Practice Address - Phone:316-361-0662
Practice Address - Fax:844-766-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200965900DMedicaid