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General NPI Number Information
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NPI Number | 1487450367
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Entity Type | Organization
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Legal Business Name | PEERCONNECT AT ICT
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 6953 E KENTFORD CIR
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City | WICHITA
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State | KS
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Zip | 67226-1026
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Country | US
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Telephone | 316-730-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 6953 E KENTFORD CIR
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City | WICHITA
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State | KS
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Zip | 67226-1026
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Country | US
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Telephone | 316-730-3110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS CHRISTINE NGUYEN
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Credential |
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Telephone | 316-730-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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