MEDICARE: SOUTHWEST KANSAS BEHAVIORAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023905445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST KANSAS BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2006 1ST AVE STE 602
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2623
Country	:	US
Telephone Number	:	620-253-5789
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 1ST AVE STE 602
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2623
Country	:	US
Telephone Number	:	620-253-5789
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JENNIFER ANN BLACKBURN
Credential	:	PMHNP
Telephone Number	:	620-253-5789

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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