Healthcare Provider Details

I. General information

NPI: 1871718221
Provider Name (Legal Business Name): MENTAL HEALTH COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 W 6TH ST STE B
LAWRENCE KS
66049-3607
US

IV. Provider business mailing address

4321 W 6TH ST STE B
LAWRENCE KS
66049-3607
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-5555
  • Fax: 785-841-8781
Mailing address:
  • Phone: 785-841-5555
  • Fax: 785-841-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number04-23223 AND 0986
License Number StateKS

VIII. Authorized Official

Name: DR. JOHN RAYMOND WHIPPLE
Title or Position: OWNER
Credential: MD
Phone: 785-841-5555