Basic Information
Provider Information | |||||||||
NPI: | 1780832030 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCCAFFREY | ||||||||
FirstName: | ADAM | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LSCSW, LMAC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 747 | ||||||||
Address2: |   | ||||||||
City: | MANHATTAN | ||||||||
State: | KS | ||||||||
PostalCode: | 665050747 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7855874300 | ||||||||
FaxNumber: | 7855874377 | ||||||||
Practice Location | |||||||||
Address1: | 1558 HAYES DR | ||||||||
Address2: |   | ||||||||
City: | MANHATTAN | ||||||||
State: | KS | ||||||||
PostalCode: | 665025068 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7855874333 | ||||||||
FaxNumber: | 7855874339 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/28/2008 | ||||||||
LastUpdateDate: | 03/29/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X |   |   | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 305 | KS | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 4283 | KS | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 7740 | KS | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 101YA0400X | 158 | KS | Y |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
ID | Type | State | Issuer | Description | 200655350A | 05 | KS |   | MEDICAID | 201531 | 01 |   | HEALTH PARTNERS OF KS | OTHER |