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Organization
MODRELL CLINICAL SERVICES LLC
Active
Organization
MODRELL CLINICAL SERVICES LLC
Active
Other names
Fireside Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN MODRELL LSCSW (CLINICAL SOCIAL WORKER)
(913) 662-3627
Entity
Organization
Contact information
Practice address
1201 WAKARUSA DR STE E107, LAWRENCE, KS 66049-3913
(913) 662-3627
Mailing address
1201 WAKARUSA DR STE E107, LAWRENCE, KS 66049-3913
(913) 662-3627
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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