1437468345 NPI number — TERESA REICHART-VERNON, LSCSW LLC

Table of content: (NPI 1437468345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437468345 NPI number — TERESA REICHART-VERNON, LSCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERESA REICHART-VERNON, LSCSW LLC
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:
TERESA REICHART-VERNON, LSCSW
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:
1437468345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10601 KAW DR
Provider Second Line Business Mailing Address:
STE. B
Provider Business Mailing Address City Name:
EDWARDSVILLE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66111-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-207-7674
Provider Business Mailing Address Fax Number:
913-745-8040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10601 KAW DR
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66111-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-207-7674
Provider Business Practice Location Address Fax Number:
913-745-8040
Provider Enumeration Date:
09/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
REICHART-VERNON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-207-7674

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LSCSW 1463 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 513729271 . This is a "MHNET" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 831649000 . This is a "MAGELLAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "PHP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "WELLPOINT" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100079970C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36520013 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "COVENTRY/FIRST HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: REICHART-VERNON . This is a "ENI/BMH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "UBH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "TRICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "APS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 513729271 . This is a "LIFESYNCH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 563233 . This is a "VALUEOPTIONS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com