Provider Demographics
NPI:1801641147
Name:AGAPE THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:AGAPE THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:INGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:316-347-1519
Mailing Address - Street 1:11924 W TAFT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1050
Mailing Address - Country:US
Mailing Address - Phone:316-665-4035
Mailing Address - Fax:316-333-2759
Practice Address - Street 1:11924 W TAFT ST STE 105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1050
Practice Address - Country:US
Practice Address - Phone:316-665-4035
Practice Address - Fax:316-333-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty