=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861803074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A1 COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2014
-----------------------------------------------------
Last Update Date | 06/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1333 N BROADWAY AVE STE E
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-2894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-201-1676
-----------------------------------------------------
Fax | 316-201-1762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1333 N BROADWAY AVE STE E
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-2894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-201-1676
-----------------------------------------------------
Fax | 316-201-1762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. LARRY L. SMITH
-----------------------------------------------------
Credential | LSCSW
-----------------------------------------------------
Telephone | 316-617-2987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4190
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------