Provider Demographics
NPI:1386875078
Name:COMPLETE CIRCLE COUNSELING & COACHING, P.A.
Entity type:Organization
Organization Name:COMPLETE CIRCLE COUNSELING & COACHING, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LSCSW
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-694-4078
Mailing Address - Street 1:127 E AVENUE B STE B
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-7422
Mailing Address - Country:US
Mailing Address - Phone:620-259-7993
Mailing Address - Fax:620-259-7994
Practice Address - Street 1:127 E AVENUE B STE B
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-7422
Practice Address - Country:US
Practice Address - Phone:620-259-7993
Practice Address - Fax:620-259-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS38741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098120AMedicaid