Organization
INTEGRATIVE PSYCHOTHERAPY LLC
Active
Organization
INTEGRATIVE PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ANNE BOULWARE MS, LMFT (OWNER)
(316) 214-8599
Entity
Organization
Contact information
Practice address
1421 N SPORT OF KINGS CT, WICHITA, KS 67230-7152
(316) 251-0896
Mailing address
1421 N SPORT OF KINGS CT, WICHITA, KS 67230-7152
(316) 214-8599
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
11/17/2023
Last updated
11/17/2023
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