Healthcare Provider Details

I. General information

NPI: 1083089627
Provider Name (Legal Business Name): BEHAVIORAL GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WOODLAWN ST STE 30
WICHITA KS
67208-4333
US

IV. Provider business mailing address

PO BOX 17053
WICHITA KS
67217-0053
US

V. Phone/Fax

Practice location:
  • Phone: 316-944-3940
  • Fax: 316-946-0694
Mailing address:
  • Phone: 316-944-3940
  • Fax: 316-946-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3789
License Number StateKS

VIII. Authorized Official

Name: LORRY A. SWAYZE
Title or Position: BILLING MGR.
Credential:
Phone: 316-944-3940