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General NPI Number Information
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NPI Number | 1497980585
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Entity Type | Organization
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Legal Business Name | HAYSVILLE MENTAL HEALTH & SUBSTANCE ABUSE, INC
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 301 W GRAND AVE
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City | HAYSVILLE
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State | KS
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Zip | 67060-1201
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Country | US
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Telephone | 316-522-1444
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Fax | 316-361-0679
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Provider Business Mailing Address
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Address Line | 1931 W COUNTRY LAKES ST
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City | HAYSVILLE
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State | KS
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Zip | 67060-5601
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Country | US
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Telephone | 316-522-1444
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Fax | 316-361-0679
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. LISA CRENSHAW
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Credential | PHD
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Telephone | 316-522-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LCP 116
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License Number State | KS
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