1962608893 NPI number — SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER INC

Table of content: (NPI 1962608893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962608893 NPI number — SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE COUNSELING CENTER - WAIVER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962608893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 S GORDY
Provider Second Line Business Mailing Address:
3
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-321-6088
Provider Business Mailing Address Fax Number:
316-321-3957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S GORDY
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-321-6088
Provider Business Practice Location Address Fax Number:
316-321-3957
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROMANO
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF FINANCE & HR
Authorized Official Telephone Number:
316-321-6088

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  024 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: 024 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , with the licence number: 024 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 024 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006905 . This is a "BCBS NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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