Provider Demographics
NPI:1285158683
Name:WEST CENTRAL MENTAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:WEST CENTRAL MENTAL HEALTH CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KAISNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-275-2351
Mailing Address - Street 1:3225 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9380
Mailing Address - Country:US
Mailing Address - Phone:719-275-2351
Mailing Address - Fax:
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-8309
Practice Address - Country:US
Practice Address - Phone:719-783-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CENTRAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-28
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15A935251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04200093Medicaid