Healthcare Provider Details

I. General information

NPI: 1881621480
Provider Name (Legal Business Name): REBECCA M BEUS LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 AVENUE K
ELLSWORTH KS
67439-4288
US

IV. Provider business mailing address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

V. Phone/Fax

Practice location:
  • Phone: 785-472-4453
  • Fax: 785-472-5352
Mailing address:
  • Phone: 888-878-6881
  • Fax: 785-826-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW 6235
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4679
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: