=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295498202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAW VALLEY COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2021
-----------------------------------------------------
Last Update Date | 10/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6734 LINCOLN RD
-----------------------------------------------------
City | OSKALOOSA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66066-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-236-8060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 161
-----------------------------------------------------
City | OSKALOOSA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66066-0161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CRYSTAL LEMING
-----------------------------------------------------
Credential | LCP
-----------------------------------------------------
Telephone | 785-236-8060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------