Organization
CHURCH THERAPY ASSOCIATES, LLC
Active
Organization
CHURCH THERAPY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN KANSIEWICZ PHD, LPC (DIRECTOR, LPC)
(781) 367-2383
Entity
Organization
Contact information
Practice address
3112 W GRAND ST, SPRINGFIELD, MO 65802-5201
(781) 367-2383
Mailing address
4223 E STATE HIGHWAY AA, SPRINGFIELD, MO 65803-5772
(781) 367-2383
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053428722
—
MA
Enumeration date
02/21/2023
Last updated
02/21/2023
Update your record
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