Basic Information
Provider Information
NPI: 1689710568
EntityType: 2
ReplacementNPI:  
OrganizationName: MENTAL HEALTH ASSOCIATION OF SOUTH CENTRAL KANSAS, INC.
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Mailing Information
Address1: 555 N WOODLAWN ST
Address2: SUITE 3105
City: WICHITA
State: KS
PostalCode: 672083646
CountryCode: US
TelephoneNumber: 3166851821
FaxNumber: 3166850768
Practice Location
Address1: 555 N WOODLAWN ST
Address2: SUITE 3105
City: WICHITA
State: KS
PostalCode: 672083645
CountryCode: US
TelephoneNumber: 3166851821
FaxNumber: 3166850768
Other Information
ProviderEnumerationDate: 01/29/2007
LastUpdateDate: 04/03/2013
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MANNING
AuthorizedOfficialFirstName: CAROL
AuthorizedOfficialMiddleName: M.
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 3166851821
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: APRN
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

ID Information
IDTypeStateIssuerDescription
KA214301KSMEDICARE PTANOTHER
100229210A05KS MEDICAID


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