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General NPI Number Information
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NPI Number | 1629535265
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Entity Type | Organization
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Legal Business Name | KANSAS MENTAL HEALTH MEDICINE LLC
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 6432 E 34TH ST N STE 100
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City | WICHITA
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State | KS
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Zip | 67226-2537
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Country | US
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Telephone | 316-260-8700
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Fax | 316-201-1071
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Provider Business Mailing Address
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Address Line | 6432 E 34TH ST N STE 100
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City | WICHITA
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State | KS
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Zip | 67226-2537
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Country | US
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Telephone | 316-260-8700
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Fax | 316-201-1071
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | TREVER KREHBIEL
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Credential | MD
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Telephone | 316-260-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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