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General NPI Number Information
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NPI Number | 1275011462
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Entity Type | Organization
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Legal Business Name | TAG TREATMENT CENTER LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 515 N RIDGE RD STE 200
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City | WICHITA
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State | KS
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Zip | 67212-6389
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Country | US
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Telephone | 316-409-0565
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Fax | 855-915-0285
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Provider Business Mailing Address
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Address Line | PO BOX 313
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City | AUGUSTA
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State | KS
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Zip | 67010-0313
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Country | US
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Telephone | 316-409-0565
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Fax | 855-915-0285
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Authorized Official
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Title or Position | CEO
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Name | ANA LIZA SCULLY-SKINNER
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Credential | LCMFT, LCAC
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Telephone | 316-409-0565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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Taxonomy #6
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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Taxonomy #8
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #9
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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Taxonomy #10
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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Taxonomy #12
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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