MEDICARE: AIR CAPITAL COUNSELING & ASSESSMENT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	103T00000X	Psychologist

General Provider Information

NPI Number	:	1619510294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIR CAPITAL COUNSELING & ASSESSMENT, LLC

Provider Business Mailing Address
First Line	:	2420 N WOODLAWN BLVD STE 300
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-3960
Country	:	US
Telephone Number	:	316-347-7157
Fax Number	:	316-247-9528

Provider Business Practice Location Address
First Line	:	2420 N WOODLAWN BLVD
Second Line	:	BLDG 300
City	:	WICHITA
State	:	KS
Zip	:	67220-3960
Country	:	US
Telephone Number	:	316-347-7157
Fax Number	:	316-247-9528

Authorized Official
Title or Position	:	OWNER
Name	:	HELEN GRZESKIEWICZ
Credential	:	LCP, LCAC
Telephone Number	:	316-347-7157

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	05/15/2025

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