Provider Demographics
NPI:1427890482
Name:MAINSTREAM MENTAL HEALTH
Entity type:Organization
Organization Name:MAINSTREAM MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-360-0806
Mailing Address - Street 1:1642 MAIN ST # 3
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2686
Mailing Address - Country:US
Mailing Address - Phone:913-360-0806
Mailing Address - Fax:913-370-8002
Practice Address - Street 1:1642 MAIN ST # 3
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2686
Practice Address - Country:US
Practice Address - Phone:913-360-0806
Practice Address - Fax:913-370-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty