Provider Demographics
NPI:1457943599
Name:TAILORED FAMILY SOLUTIONS, LLC
Entity type:Organization
Organization Name:TAILORED FAMILY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BRIDGET
Authorized Official - Last Name:JENNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:913-594-3504
Mailing Address - Street 1:209 S NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3847
Mailing Address - Country:US
Mailing Address - Phone:913-594-3504
Mailing Address - Fax:
Practice Address - Street 1:209 S NORMANDY DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3847
Practice Address - Country:US
Practice Address - Phone:913-594-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200517280AMedicaid