Provider Demographics
NPI:1285744938
Name:THEIS, JOHN FRANCIS (LSCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:THEIS
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67505-2025
Mailing Address - Country:US
Mailing Address - Phone:620-662-6658
Mailing Address - Fax:
Practice Address - Street 1:23 E 1ST AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-7146
Practice Address - Country:US
Practice Address - Phone:620-662-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 14041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical