Healthcare Provider Details

I. General information

NPI: 1548989262
Provider Name (Legal Business Name): JOHNSON COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 07/18/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 NIEMAN RD
SHAWNEE KS
66203-3326
US

IV. Provider business mailing address

6000 LAMAR AVE STE 130
MISSION KS
66202-3234
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYDIA LONGORIA
Title or Position: QI REPRESENTATIVE
Credential:
Phone: 913-826-4200