MEDICARE: BETTY K. SKINNER, LSCSW, INC.

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		KS

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	:	1700076296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTY K. SKINNER, LSCSW, INC.

Provider Business Mailing Address
First Line	:	2135 N SUNRIDGE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-1503
Country	:	US
Telephone Number	:	316-201-1080
Fax Number	:	316-201-1085

Provider Business Practice Location Address
First Line	:	2135 N SUNRIDGE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-1503
Country	:	US
Telephone Number	:	316-201-1080
Fax Number	:	316-201-1085

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. BETTY K. SKINNER
Credential	:	LSCSW, ACSW
Telephone Number	:	316-201-1080

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	08/06/2013

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