Healthcare Provider Details

I. General information

NPI: 1720181936
Provider Name (Legal Business Name): PRAIRIE VIEW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 HOSPITAL DR
MCPHERSON KS
67460-2318
US

IV. Provider business mailing address

PO BOX 467
NEWTON KS
67114-0467
US

V. Phone/Fax

Practice location:
  • Phone: 620-245-5000
  • Fax: 620-245-5099
Mailing address:
  • Phone: 316-284-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number998
License Number StateKS

VIII. Authorized Official

Name: MARCY JOHNSON
Title or Position: PRESIDENT & CEO
Credential: LCAC
Phone: 316-284-6310