| Ccf Mental Health Consultation Pa | |
|
9415 E Harry St Ste 305 Wichita KS 67207-5077 | |
| (316) 258-2409 | |
| (316) 285-0527 |
| Full Name | Ccf Mental Health Consultation Pa |
|---|---|
| Speciality | Social Worker |
| Location | 9415 E Harry St Ste 305, Wichita, Kansas |
| Authorized Official Name and Position | Cynthia Colleen Fulford (OWNER) |
| Authorized Official Contact | 3162582409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccf Mental Health Consultation Pa 2022 S Webb Rd Ste 261 Wichita KS 67207-5627 Ph: (316) 258-2409 | Ccf Mental Health Consultation Pa 9415 E Harry St Ste 305 Wichita KS 67207-5077 Ph: (316) 258-2409 |
| NPI Number | 1871172429 |
|---|---|
| Provider Enumeration Date | 04/02/2021 |
| Last Update Date | 04/07/2021 |
| Certification Date | 04/07/2021 |
| Medicare PECOS PAC ID | 5294143863 |
|---|---|
| Medicare Enrollment ID | O20210420001321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871172429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Cynthia Colleen Fulford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962749721 PECOS PAC ID: 6103063714 Enrollment ID: I20190320002125 |
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