Provider Demographics
NPI:1427333756
Name:MIDAMERICA FAMILY TREATMENT CENTER
Entity type:Organization
Organization Name:MIDAMERICA FAMILY TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:913-626-1018
Mailing Address - Street 1:PO BOX 25172
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5172
Mailing Address - Country:US
Mailing Address - Phone:913-626-1018
Mailing Address - Fax:913-217-7469
Practice Address - Street 1:2601 W 121ST ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1178
Practice Address - Country:US
Practice Address - Phone:913-626-1018
Practice Address - Fax:913-217-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSFL1141844251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200537650CMedicaid