Provider Demographics
NPI:1538155882
Name:SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:SOUTH CENTRAL MENTAL HEALTH COUNSELING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-775-5491
Mailing Address - Street 1:520 E. AUGUSTA AVE.
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010
Mailing Address - Country:US
Mailing Address - Phone:316-775-5491
Mailing Address - Fax:316-775-5442
Practice Address - Street 1:2365 W. CENTRAL
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042
Practice Address - Country:US
Practice Address - Phone:316-321-6036
Practice Address - Fax:316-321-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS024101YA0400X, 103TC0700X, 103TF0200X, 1041C0700X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097960BMedicaid
KS200001090AMedicaid
KS100097960AMedicaid
KS200001090AMedicaid