Basic Information
| Provider Information | |||||||||
| NPI: | 1831508589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENTAL HEALTH ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N WOODLAWN ST # 130 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083646 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N WOODLAWN ST # 130 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166520952 | ||||||||
| FaxNumber: | 3166522595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2014 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | SMALLEY | ||||||||
| AuthorizedOfficialFirstName: | HELEN | ||||||||
| AuthorizedOfficialMiddleName: | FRANCES | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED ADDICTIONS COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 3166522590 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 337 | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.