Basic Information
| Provider Information | |||||||||
| NPI: | 1538420526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERSCHEN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3166607510 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 N AMIDON AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672032117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607540 | ||||||||
| FaxNumber: | 3166607510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 06/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 8388 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.