Basic Information
| Provider Information | |||||||||
| NPI: | 1164177291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAILLA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 688 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673010688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203311748 | ||||||||
| FaxNumber: | 6203321940 | ||||||||
| Practice Location | |||||||||
| Address1: | 3354 HIGHWAY 160 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673017841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203311748 | ||||||||
| FaxNumber: | 6203321940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2022 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2705 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.