Healthcare Provider Details

I. General information

NPI: 1477162741
Provider Name (Legal Business Name): CENTRAL KANSAS PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W MAIN ST STE B103
LYONS KS
67554-1927
US

IV. Provider business mailing address

116 W FOREST AVE
STERLING KS
67579-1516
US

V. Phone/Fax

Practice location:
  • Phone: 620-312-3861
  • Fax:
Mailing address:
  • Phone: 620-204-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER ANN DYSON
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 620-204-8504