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General NPI Number Information
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NPI Number | 1477162741
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Entity Type | Organization
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Legal Business Name | CENTRAL KANSAS PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 103 W MAIN ST STE B103
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City | LYONS
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State | KS
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Zip | 67554-1927
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Country | US
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Telephone | 620-312-3861
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Fax |
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Provider Business Mailing Address
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Address Line | 116 W FOREST AVE
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City | STERLING
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State | KS
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Zip | 67579-1516
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Country | US
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Telephone | 620-204-8504
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JENNIFER ANN DYSON
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Credential | PSY.D.
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Telephone | 620-204-8504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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License Number State |
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