Provider Demographics
NPI:1992230510
Name:SUNFLOWER PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SUNFLOWER PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BASE
Authorized Official - Suffix:
Authorized Official - Credentials:LCP
Authorized Official - Phone:316-201-3125
Mailing Address - Street 1:209 E WILLIAM ST STE 535
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-4015
Mailing Address - Country:US
Mailing Address - Phone:316-201-3125
Mailing Address - Fax:
Practice Address - Street 1:209 E WILLIAM ST STE 535
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4015
Practice Address - Country:US
Practice Address - Phone:316-201-3125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2740101YP2500X
KS2623101YP2500X
KS2609103T00000X
KS2445103T00000X
KS1465103TC0700X
KS248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty