Provider Demographics
NPI:1962766733
Name:SUSAN WARDEN THERAPY, LLC
Entity type:Organization
Organization Name:SUSAN WARDEN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LAURENT
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFA
Authorized Official - Phone:785-760-2026
Mailing Address - Street 1:24 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2565
Mailing Address - Country:US
Mailing Address - Phone:913-735-4605
Mailing Address - Fax:913-469-4242
Practice Address - Street 1:10965 GRANADA LN
Practice Address - Street 2:SUITE 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1469
Practice Address - Country:US
Practice Address - Phone:913-735-4605
Practice Address - Fax:913-469-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMFT 2377251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health