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General NPI Number Information
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NPI Number | 1912777046
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Entity Type | Organization
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Legal Business Name | AT PROVIDER GROUP OF KANSAS PA
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 9393 W 110TH ST STE 500
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City | OVERLAND PARK
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State | KS
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Zip | 66210-1464
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Country | US
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Telephone | 845-769-8758
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 BORO PL FL 4
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City | MC LEAN
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State | VA
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Zip | 22102-3627
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Country | US
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Telephone | 845-769-8758
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | KARLA RENEE MULLINGS
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Credential |
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Telephone | 834-769-8758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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