Provider Demographics
NPI:1285902676
Name:INSIGHT COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:INSIGHT COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:LCAC, LMLP
Authorized Official - Phone:316-409-2960
Mailing Address - Street 1:4618 E CENTRAL AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3956
Mailing Address - Country:US
Mailing Address - Phone:316-440-4804
Mailing Address - Fax:316-440-4814
Practice Address - Street 1:4618 E CENTRAL AVE STE 30
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3956
Practice Address - Country:US
Practice Address - Phone:316-440-4804
Practice Address - Fax:316-440-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07400971261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center