Provider Demographics
NPI:1962608893
Name:SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER INC
Entity type:Organization
Organization Name:SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & HR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-321-6088
Mailing Address - Street 1:120 S GORDY
Mailing Address - Street 2:3
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042
Mailing Address - Country:US
Mailing Address - Phone:316-321-6088
Mailing Address - Fax:316-321-3957
Practice Address - Street 1:120 S GORDY
Practice Address - Street 2:3
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042
Practice Address - Country:US
Practice Address - Phone:316-321-6088
Practice Address - Fax:316-321-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS024101YA0400X, 101YM0800X, 103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS006905OtherBCBS NUMBER
KS006905OtherBCBS NUMBER