Basic Information
| Provider Information | |||||||||
| NPI: | 1699239558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELVIN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 COLLEEN ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670102309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162599205 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9415 E HARRY ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672075084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166851821 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11160 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.