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Organization
BESPOKE THERAPY & CO. LLC
Active
Organization
BESPOKE THERAPY & CO. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVANGELINE CLAIRE PAYNE LSCSW (OWNER)
(316) 631-2454
Entity
Organization
Contact information
Practice address
555 N WOODLAWN ST STE 120, WICHITA, KS 67208-3678
(316) 631-2454
(316) 669-8500
Mailing address
168 S WELLCREST CT, GODDARD, KS 67052-9591
(316) 631-2454
(316) 669-8500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
09/11/2025
Last updated
09/11/2025
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