Healthcare Provider Details

I. General information

NPI: 1356122998
Provider Name (Legal Business Name): SOUTHEAST KANSAS MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S PLUMMER AVE
CHANUTE KS
66720-1950
US

IV. Provider business mailing address

PO BOX 39
HUMBOLDT KS
66748-0039
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-2500
  • Fax: 620-431-4418
Mailing address:
  • Phone: 620-473-2241
  • Fax: 620-473-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS WRIGHT
Title or Position: INTERIM CEO
Credential:
Phone: 620-365-8641