# MODRELL CLINICAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fireside Counseling
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396439345
- **Authorized official:** JUSTIN MODRELL LSCSW (CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (913) 662-3627

## Contact information

- **Practice address:** 1201 WAKARUSA DR STE E107, LAWRENCE, KS 66049-3913
- **Practice address phone:** (913) 662-3627
- **Mailing address:** 1201 WAKARUSA DR STE E107, LAWRENCE, KS 66049-3913
- **Mailing address phone:** (913) 662-3627

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 06/05/2023
- **Last updated:** 06/05/2023