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General NPI Number Information
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NPI Number | 1174568398
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Entity Type | Organization
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Legal Business Name | RECOVERY UNLIMITED, INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3312 W DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67203-5422
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Country | US
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Telephone | 316-941-9948
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Fax | 316-943-7195
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Provider Business Mailing Address
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Address Line | 3312 W DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67203-5422
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Country | US
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Telephone | 316-941-9948
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Fax | 316-943-7195
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JERRY LYLE PHILBRICK
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Credential | CADC
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Telephone | 316-941-9948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 429
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License Number State | KS
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