Basic Information
| Provider Information | |||||||||
| NPI: | 1699003186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOERING | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 NORTH EXPOSITION | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162648317 | ||||||||
| FaxNumber: | 3162640347 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 S BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672024304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166609600 | ||||||||
| FaxNumber: | 3166609660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2009 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3911 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.