Healthcare Provider Details

I. General information

NPI: 1245390251
Provider Name (Legal Business Name): COTTON O'NEIL CLINIC RECOVABLE TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 SW 6TH AVE
TOPEKA KS
66606-2084
US

IV. Provider business mailing address

901 SW GARFIELD AVE
TOPEKA KS
66606-1670
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-4600
  • Fax: 785-270-4601
Mailing address:
  • Phone: 785-354-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA YOCUM
Title or Position: VICE PRESIDENT
Credential:
Phone: 785-354-9591