Basic Information
| Provider Information | |||||||||
| NPI: | 1356648273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CENTER FOR SOCIAL WORK INNOVATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3425 W CENTRAL AVE STE 100-102 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672034919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162538303 | ||||||||
| FaxNumber: | 3169460694 | ||||||||
| Practice Location | |||||||||
| Address1: | 3425 W CENTRAL AVE STE 100-102 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672034919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162538303 | ||||||||
| FaxNumber: | 3169460694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2011 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | RUTENBECK | ||||||||
| AuthorizedOfficialFirstName: | TAUNYA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER-SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 3162538303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7922 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.