| NPI | 1487650842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA CLARK Billing Manager 785-272-5566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 311) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 1366) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-20537) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2020-06-24 |