MEDICARE: MEADOWLARK COUNSELING, 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
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316569643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWLARK COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	ARLINGTON
State	:	KS
Zip	:	67514-0051
Country	:	US
Telephone Number	:	620-960-7414
Fax Number	:	620-259-7994

Provider Business Practice Location Address
First Line	:	1 N MAIN ST STE 416
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5250
Country	:	US
Telephone Number	:	620-960-7414
Fax Number	:	888-516-0964

Authorized Official
Title or Position	:	THERAPIST
Name	:	KEVIN R MARTIN NISLY
Credential	:	LSCSW
Telephone Number	:	620-960-7414

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	03/15/2024

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