Provider Demographics
NPI:1861803074
Name:A1 COUNSELING, LLC
Entity type:Organization
Organization Name:A1 COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-617-2987
Mailing Address - Street 1:1333 N BROADWAY AVE
Mailing Address - Street 2:STE E
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2894
Mailing Address - Country:US
Mailing Address - Phone:316-201-1676
Mailing Address - Fax:316-201-1762
Practice Address - Street 1:1333 N BROADWAY AVE
Practice Address - Street 2:STE E
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2894
Practice Address - Country:US
Practice Address - Phone:316-201-1676
Practice Address - Fax:316-201-1762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARRY SMITH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-12
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS41901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200565510BMedicaid