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General NPI Number Information
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NPI Number | 1205129863
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Entity Type | Organization
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Legal Business Name | URBAN LEAGUE OF KANSAS
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 2418 E 9TH ST N
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City | WICHITA
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State | KS
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Zip | 67214-3150
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Country | US
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Telephone | 316-262-2463
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Fax | 316-262-8841
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Provider Business Mailing Address
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Address Line | 2418 E 9TH ST N
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City | WICHITA
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State | KS
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Zip | 67214-3150
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | YOUTH EMPOWERMENT PROGRAM DIRECTOR
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Name | JASON MCKENNEY
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Credential | LMSW
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Telephone | 316-440-9241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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