Provider Demographics
NPI:1992272025
Name:CHRISTINA GRANADOS THERAPY LLC
Entity type:Organization
Organization Name:CHRISTINA GRANADOS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANADOS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-202-8549
Mailing Address - Street 1:2420 N AMARADO ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1521
Mailing Address - Country:US
Mailing Address - Phone:316-202-8549
Mailing Address - Fax:
Practice Address - Street 1:727 N WACO AVE STE 575
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3951
Practice Address - Country:US
Practice Address - Phone:316-202-8549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty