Basic Information
| Provider Information | |||||||||
| NPI: | 1437767571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KVC BEHAVIORAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23150 W. 153RD ST. | ||||||||
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| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660618565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133224950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 419 SW 29TH ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666111105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854096801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2020 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | FEIGHNER | ||||||||
| AuthorizedOfficialFirstName: | SHILOAH | ||||||||
| AuthorizedOfficialMiddleName: | MERNISSA MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | ALCOHOL AND DRUG COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 9133689206 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LAC | ||||||||
| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.