Provider Demographics
NPI:1386937852
Name:LINES PSYCHOTHERAPY AND HOME STUDIES
Entity type:Organization
Organization Name:LINES PSYCHOTHERAPY AND HOME STUDIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:620-669-0902
Mailing Address - Street 1:1818 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1106
Mailing Address - Country:US
Mailing Address - Phone:620-669-2396
Mailing Address - Fax:620-669-2394
Practice Address - Street 1:1714 E 30TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1262
Practice Address - Country:US
Practice Address - Phone:620-669-0902
Practice Address - Fax:620-663-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13921041C0700X
KS2591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty