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General NPI Number Information
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NPI Number | 1770969925
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Entity Type | Organization
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Legal Business Name | HOLISTIC MENTAL & BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 820 N MAIN ST
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City | WICHITA
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State | KS
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Zip | 67203-3605
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Country | US
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Telephone | 913-702-6722
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Fax |
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Provider Business Mailing Address
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Address Line | 820 N MAIN ST
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City | WICHITA
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State | KS
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Zip | 67203-3605
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Country | US
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Telephone | 913-702-6722
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CHRISTY LEE FOOS
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Credential | LMSW, LAC
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Telephone | 913-702-6722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9122
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License Number State | KS
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