Provider Demographics
NPI:1396089694
Name:SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER
Entity type:Organization
Organization Name:SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCIMIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-755-5491
Mailing Address - Street 1:2365 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3208
Mailing Address - Country:US
Mailing Address - Phone:316-321-6036
Mailing Address - Fax:
Practice Address - Street 1:2365 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3208
Practice Address - Country:US
Practice Address - Phone:316-321-6036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMLP 2425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty