# BESPOKE THERAPY & CO. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245111574
- **Authorized official:** EVANGELINE CLAIRE PAYNE LSCSW (OWNER)
- **Authorized official phone:** (316) 631-2454

## Contact information

- **Practice address:** 555 N WOODLAWN ST STE 120, WICHITA, KS 67208-3678
- **Practice address phone:** (316) 631-2454
- **Practice address fax:** (316) 669-8500
- **Mailing address:** 168 S WELLCREST CT, GODDARD, KS 67052-9591
- **Mailing address phone:** (316) 631-2454
- **Mailing address fax:** (316) 669-8500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |

## Other

- **Enumeration date:** 09/11/2025
- **Last updated:** 09/11/2025