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General NPI Number Information
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NPI Number | 1275777328
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Entity Type | Organization
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Legal Business Name | DERBY EMOTIONAL WELLNESS
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 1721 E OSAGE SUITE 300
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City | DERBY
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State | KS
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Zip | 67037-2290
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Country | US
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Telephone | 316-788-1907
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Fax | 316-788-1941
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Provider Business Mailing Address
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Address Line | 1721 E OSAGE SUITE 300
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City | DERBY
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State | KS
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Zip | 67037-2290
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Country | US
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Telephone | 316-788-1907
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Fax | 316-788-1941
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Authorized Official
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Title or Position | PHD, LSCSW
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Name | ALICIA ANN MYERS-LANDSVERK
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Credential | LSCSW
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Telephone | 316-788-1907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1527
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 74173
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4695
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1527
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License Number State | KS
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