Basic Information
| Provider Information | |||||||||
| NPI: | 1245717826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DBT CENTER OF LAWRENCE AND KANSAS CITY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 WAKARUSA DR STE 2100 | ||||||||
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| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854247770 | ||||||||
| FaxNumber: | 7854247733 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 WAKARUSA DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129141425 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2018 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | DUHIGG | ||||||||
| AuthorizedOfficialFirstName: | ALYSSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7854247770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2810 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 30004605360001 | 05 | KS | MEDICAID |