MEDICARE: MICHAEL S GROVER LMSW, LCAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	567	KS
2	104100000X	Social Worker	6823	KS

General Provider Information

NPI Number	:	1720742554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S GROVER LMSW, LCAC

Provider Business Mailing Address
First Line	:	121 S WHITTIER RD STE 360
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-1064
Country	:	US
Telephone Number	:	816-866-7039
Fax Number	:	316-351-6446

Provider Business Practice Location Address
First Line	:	121 S WHITTIER RD STE 360
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-1064
Country	:	US
Telephone Number	:	816-866-7039
Fax Number	:	316-351-6446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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