=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427264712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL HEALTH AND WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 11/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 N ROCK RD STE. 212
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-683-0700
-----------------------------------------------------
Fax | 316-440-8634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 N ROCK RD STE. 212
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-683-0700
-----------------------------------------------------
Fax | 316-440-8634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | LYN LOUISE CAIN COURTNEY
-----------------------------------------------------
Credential | LSCSW
-----------------------------------------------------
Telephone | 316-683-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LSCSW 1965
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------