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NPI Code Detail

MEDICARE: TAG TREATMENT CENTER LLC

MEDICARE: TAG TREATMENT CENTER LLC
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
1101YM0800XMental Health Counselor
2261QM1300XMulti-Specialty Clinic/Center
3103TC2200XClinical Child & Adolescent Psychologist
41041C0700XClinical Social Worker
5101YP2500XProfessional Counselor
6364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
7103TC0700XClinical Psychologist
8261QM0850XAdult Mental Health Clinic/Center
9101YA0400XAddiction (Substance Use Disorder) Counselor
10171M00000XCase Manager/Care Coordinator
11261QM0855XAdolescent and Children Mental Health Clinic/Center
12102L00000XPsychoanalyst
13106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1275011462
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAG TREATMENT CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 313
Second Line :
City : AUGUSTA
State : KS
Zip : 67010-0313
Country : US
Telephone Number : 316-409-0565
Fax Number : 855-915-0285
Provider Business Practice Location Address
First Line : 515 N RIDGE RD STE 200
Second Line :
City : WICHITA
State : KS
Zip : 67212-6389
Country : US
Telephone Number : 316-409-0565
Fax Number : 855-915-0285
Authorized Official
Title or Position : CEO
Name : ANA LIZA SCULLY-SKINNER
Credential : LCMFT, LCAC
Telephone Number : 316-409-0565
Provider Enumeration Date : 07/31/2018
Last Update Date : 12/09/2025

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