Healthcare Provider Details

I. General information

NPI: 1861585473
Provider Name (Legal Business Name): ADOLESCENT SPECIALISTS OF KANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NORTH CARRIAGE PARKWAY SUITE 135
WICHITA KS
67208-4514
US

IV. Provider business mailing address

650 NORTH CARRIAGE PARKWAY SUITE 135
WICHITA KS
67208-4514
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-4700
  • Fax: 316-685-8247
Mailing address:
  • Phone: 316-685-4700
  • Fax: 316-685-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number619
License Number StateKS

VIII. Authorized Official

Name: MS. ANNE M DOLAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 316-685-4700