=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437767571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KVC BEHAVIORAL HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2020
-----------------------------------------------------
Last Update Date | 07/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 SW 29TH ST
-----------------------------------------------------
City | TOPEKA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66611-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-409-6801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23150 W. 153RD ST.
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-8565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-322-4950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ALCOHOL AND DRUG COUNSELOR
-----------------------------------------------------
Name | MS. SHILOAH MERNISSA MARIE FEIGHNER
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 913-368-9206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------