Healthcare Provider Details

I. General information

NPI: 1114433059
Provider Name (Legal Business Name): KANSAS FAMILY ADVISORY NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E ENGLISH ST STE 250
WICHITA KS
67202-4315
US

IV. Provider business mailing address

PO BOX 8577
WICHITA KS
67208-0577
US

V. Phone/Fax

Practice location:
  • Phone: 316-529-9137
  • Fax: 316-529-9137
Mailing address:
  • Phone: 316-529-9137
  • Fax: 316-529-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NINA ADRIENNE SHAW-WOODY
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 316-529-9137