Provider Demographics
NPI:1841052057
Name:BROUS PROFESSIONAL SERVICES, LLC
Entity type:Organization
Organization Name:BROUS PROFESSIONAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCAC
Authorized Official - Phone:785-269-1011
Mailing Address - Street 1:2703 HALL ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1964
Mailing Address - Country:US
Mailing Address - Phone:785-269-1011
Mailing Address - Fax:785-203-3030
Practice Address - Street 1:2703 HALL ST STE 5
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1964
Practice Address - Country:US
Practice Address - Phone:785-269-1011
Practice Address - Fax:785-329-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid