Provider Demographics
NPI:1427439546
Name:MENTAL HEALTH ASSOCIATION OF SCK
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF SCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIAILIST
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-685-1821
Mailing Address - Street 1:555 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3646
Mailing Address - Country:US
Mailing Address - Phone:316-685-1821
Mailing Address - Fax:316-685-0768
Practice Address - Street 1:555 N WOODLAWN
Practice Address - Street 2:S 3105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-685-1821
Practice Address - Fax:316-685-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2143Medicare PIN