Healthcare Provider Details

I. General information

NPI: 1306256532
Provider Name (Legal Business Name): ABA AND MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 E 22ND ST N STE 1600B
WICHITA KS
67226
US

IV. Provider business mailing address

8100 E 22ND ST N STE 1600B
WICHITA KS
67226
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6424
  • Fax: 310-201-6428
Mailing address:
  • Phone: 316-201-6424
  • Fax: 310-201-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1921
License Number StateKS

VIII. Authorized Official

Name: DR. SHELBY EVANS
Title or Position: OWNER
Credential: PHD
Phone: 316-201-6424